Individual
ALYCE RILEY BORKENHAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
609 GLACIER TRL, ROSELLE, IL 60172-1034
(630) 373-5820
Mailing address
609 GLACIER TRL, ROSELLE, IL 60172-1034
(630) 373-5820
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096005677
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0926
—
IL
Enumeration date
03/13/2020
Last updated
11/02/2023
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