Provider Demographics
NPI:1861850364
Name:VAN VLACK, ELAN INEZ (MS)
Entity Type:Individual
Prefix:
First Name:ELAN
Middle Name:INEZ
Last Name:VAN VLACK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ELAN
Other - Middle Name:INEZ
Other - Last Name:LITTLEJOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2501 W BELTLINE HWY STE 207
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2321
Mailing Address - Country:US
Mailing Address - Phone:608-417-7341
Mailing Address - Fax:608-417-5770
Practice Address - Street 1:2501 W BELTLINE HWY STE 207
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2321
Practice Address - Country:US
Practice Address - Phone:608-417-7341
Practice Address - Fax:608-417-5770
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist