Provider Demographics
NPI:1871201699
Name:VESPERO PERRY, HELOISA
Entity type:Individual
Prefix:
First Name:HELOISA
Middle Name:
Last Name:VESPERO PERRY
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 1:55 WOODLAKE BLVD APT 2506
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-6721
Mailing Address - Country:US
Mailing Address - Phone:312-998-8931
Mailing Address - Fax:
Practice Address - Street 1:55 WOODLAKE BLVD APT 2506
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-6721
Practice Address - Country:US
Practice Address - Phone:312-998-8931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21-150615106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician