Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-14-17577 | IL |
NPI | 1013307776 |
---|---|
Provider Name | Ms. Annette Grandolfo |
First Address | Aurora, IL 60502-9612 |
Second Address | Aurora, IL 60502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2015 |
Last Update Date | 03/07/2019 |