Individual
ALFONSO BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5420 N HARLEM AVE, CHICAGO, IL 60656-1800
(708) 667-0790
Mailing address
4532 S FRANCISCO AVE # 4, CHICAGO, IL 60632-1911
(872) 308-5474
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/30/2023
Last updated
03/30/2023
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