Individual
ALEXANDER WISNIEWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
581 TREETOP LN, GURNEE, IL 60031-5655
(224) 545-0125
Mailing address
581 TREETOP LN, GURNEE, IL 60031-5655
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-45142
IL
Other
Enumeration date
06/01/2018
Last updated
06/01/2018
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