Individual
ALYSSA POTACKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4954 W 95TH ST, OAK LAWN, IL 60453-2504
(630) 290-8500
Mailing address
4954 W 95TH ST, OAK LAWN, IL 60453-2504
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/27/2023
Last updated
12/27/2023
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