Provider Demographics
NPI:1427620483
Name:ANZALOTTI, CHRISTIN (MED, LBS1)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:
Last Name:ANZALOTTI
Suffix:
Gender:F
Credentials:MED, LBS1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7432 W AINSLIE ST
Mailing Address - Street 2:
Mailing Address - City:HARWOOD HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60706-3420
Mailing Address - Country:US
Mailing Address - Phone:773-818-5266
Mailing Address - Fax:
Practice Address - Street 1:7432 W AINSLIE ST
Practice Address - Street 2:
Practice Address - City:HARWOOD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60706-3420
Practice Address - Country:US
Practice Address - Phone:773-818-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
3000005OtherEI MCO