Individual
ALYSSA DOMINIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
1718 N HONORE ST APT 2R, CHICAGO, IL 60622-1332
(740) 541-8086
Mailing address
1718 N HONORE ST APT 2R, CHICAGO, IL 60622-1332
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/18/2025
Last updated
03/18/2025
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