Provider Demographics
NPI:1487397188
Name:DYE, ALICE MARY
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:MARY
Last Name:DYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 TALL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-6243
Mailing Address - Country:US
Mailing Address - Phone:847-421-6669
Mailing Address - Fax:
Practice Address - Street 1:205 COMMERCE DR STE B
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1646
Practice Address - Country:US
Practice Address - Phone:847-665-9146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490232001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical