Individual
FITHAWIT BERHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5N673 SANTA FE TRL, BLOOMINGDALE, IL 60108-2413
(630) 924-1579
Mailing address
5N673 SANTA FE TRL, BLOOMINGDALE, IL 60108-2413
(630) 924-1579
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
36-6006553
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0695
—
IL
01
—
13186
AETNA BETTER HEALTH
IL
05
—
16628
—
IL
01
—
6321
ILLINICARE
—
01
—
6692
HUMANA HEALTH PLAN INC MMP
IL
05
—
8177
—
IL
05
—
9857
—
IL
Enumeration date
10/03/2014
Last updated
10/03/2014
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