Provider Demographics
NPI:1609261486
Name:VANVALZAH, ELLYN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELLYN
Middle Name:
Last Name:VANVALZAH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 ROCK HALL CIR
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1103
Mailing Address - Country:US
Mailing Address - Phone:847-548-6259
Mailing Address - Fax:
Practice Address - Street 1:468 ROCK HALL CIR
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1103
Practice Address - Country:US
Practice Address - Phone:847-548-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist