Provider Demographics
NPI:1326641507
Name:MCNEILLY, ELIZABETH AGNES
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:AGNES
Last Name:MCNEILLY
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 1:811 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1116
Mailing Address - Country:US
Mailing Address - Phone:708-848-6154
Mailing Address - Fax:
Practice Address - Street 1:811 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1116
Practice Address - Country:US
Practice Address - Phone:708-848-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist