Individual
ALEXIS SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4989 MEADOW LAKE DR, RICHTON PARK, IL 60471-1188
(708) 518-2960
Mailing address
4989 MEADOW LAKE DR, RICHTON PARK, IL 60471-1188
(708) 518-2960
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
10/23/2018
Last updated
09/13/2019
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