Provider Demographics
NPI:1295490472
Name:SUCKOW, ALEXIA RAE (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ALEXIA
Middle Name:RAE
Last Name:SUCKOW
Suffix:
Gender:
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 N LINCOLN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3927
Mailing Address - Country:US
Mailing Address - Phone:224-701-5401
Mailing Address - Fax:
Practice Address - Street 1:6540 N LINCOLN AVE STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3927
Practice Address - Country:US
Practice Address - Phone:224-701-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-25-79883103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst