Provider Demographics
NPI:1164936431
Name:DREJAS, ELISE CHRISTINE
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:CHRISTINE
Last Name:DREJAS
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 1:7329 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1817
Mailing Address - Country:US
Mailing Address - Phone:708-467-5858
Mailing Address - Fax:
Practice Address - Street 1:7329 W 63RD ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501-1817
Practice Address - Country:US
Practice Address - Phone:708-467-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-25
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.013909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist