Provider Demographics
NPI:1740413889
Name:ABBATACOLA, ELISABETH (MA)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:ABBATACOLA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 W WALTON ST # 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4961
Mailing Address - Country:US
Mailing Address - Phone:815-258-8574
Mailing Address - Fax:
Practice Address - Street 1:2025 W WALTON ST # 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4961
Practice Address - Country:US
Practice Address - Phone:815-258-8574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242001283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist