Individual
FANNY ARCHEL MATEO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
411 EDWARDSVILLE RD, TROY, IL 62294-1339
(314) 275-0506
Mailing address
848 N 89TH ST, EAST SAINT LOUIS, IL 62203-2111
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
1214416
IL
Other
Enumeration date
02/23/2026
Last updated
02/23/2026
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