Provider Demographics
NPI:1497981732
Name:JARVIS, ELAYNE (DEVELOPMENTAL THERAP)
Entity Type:Individual
Prefix:MRS
First Name:ELAYNE
Middle Name:
Last Name:JARVIS
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:MISS
Other - First Name:ELAYNE
Other - Middle Name:
Other - Last Name:SPIESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1799 KINGS GATE LANE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014
Mailing Address - Country:US
Mailing Address - Phone:815-276-7786
Mailing Address - Fax:815-788-1321
Practice Address - Street 1:1799 KINGS GATE LANE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-276-7786
Practice Address - Fax:815-788-1321
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist