Provider Demographics
NPI:1285355040
Name:FALLON, PATRICK JOSEPH
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOSEPH
Last Name:FALLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S WILLISTON ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5914
Mailing Address - Country:US
Mailing Address - Phone:630-903-9535
Mailing Address - Fax:
Practice Address - Street 1:2100 MANCHESTER RD STE 1510
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4561
Practice Address - Country:US
Practice Address - Phone:630-653-1717
Practice Address - Fax:630-653-7926
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014822101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor