Provider Demographics
NPI:1639911878
Name:ZAVALA, ALEXIS (BCBA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 N GENEVA TER APT 318
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3344
Mailing Address - Country:US
Mailing Address - Phone:619-957-9213
Mailing Address - Fax:
Practice Address - Street 1:850 S WABASH AVE STE 320
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3642
Practice Address - Country:US
Practice Address - Phone:773-234-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst