Individual
THERESA ALEXANDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
209 REVEREND WALTON DR, LOCKPORT, IL 60441-5246
(815) 814-4220
Mailing address
209 REVEREND WALTON DR, LOCKPORT, IL 60441-5246
(815) 814-4220
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
A4258003783
IL
Other
Enumeration date
07/30/2026
Last updated
07/30/2026
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