Individual
ALONZO CHAZ ZAVALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
W3349 COUNTY ROAD NN, ELKHORN, WI 53121-4422
(815) 388-5841
Mailing address
W3349 COUNTY ROAD NN, ELKHORN, WI 53121-4422
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
IL
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861576
—
IL
Enumeration date
08/20/2018
Last updated
08/20/2018
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