Most Relevant Information
Provider Data
| NPI Number: | 1003685462 |
| Provider Name: | ALYSSA POTACKI |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/27/2023 |
| Last Updated: | 12/27/2023 |
Provider Practice Location
4954 W 95TH ST
OAK LAWN
IL
604532504
Practice Location Phone/Fax
| Phone: | 6302908500 |
| Fax: |
Provider Mailing Location
4954 W 95TH ST
OAK LAWN
IL
604532504
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |