Provider Demographics
NPI:1326496753
Name:QUEZADA, ELSA YOLANDA
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:YOLANDA
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:YOLANDA
Other - Last Name:QUEZADA-HUERTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5437 S KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4233
Mailing Address - Country:US
Mailing Address - Phone:708-359-2293
Mailing Address - Fax:
Practice Address - Street 1:5437 S KEELER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4233
Practice Address - Country:US
Practice Address - Phone:708-359-2293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist