Provider Demographics
NPI:1063815934
Name:CRESPO PAVLATOS, ELISA
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:CRESPO PAVLATOS
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 1:34163 N BLUESTEM RD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5244
Mailing Address - Country:US
Mailing Address - Phone:847-406-6995
Mailing Address - Fax:
Practice Address - Street 1:34163 N BLUESTEM RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-5244
Practice Address - Country:US
Practice Address - Phone:847-406-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist