Individual
BETHANY CARISSA INAHUAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
44 W ROOSEVELT RD, LOMBARD, IL 60148-4402
(630) 290-8500
Mailing address
8730 MERRIMAC AVE, OAK LAWN, IL 60453-1118
(312) 914-3054
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/01/2023
Last updated
11/01/2023
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