Provider Demographics
NPI:1679749725
Name:SHWATAL, ELLEN MARIE (MS, MSPH)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:SHWATAL
Suffix:
Gender:F
Credentials:MS, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 PRAIRIE CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5147
Mailing Address - Country:US
Mailing Address - Phone:630-876-8176
Mailing Address - Fax:
Practice Address - Street 1:1349 PRAIRIE CT
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-5147
Practice Address - Country:US
Practice Address - Phone:630-876-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist