Provider Demographics
NPI:1881816486
Name:WERNSMAN, ELIZABETH E (DT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:WERNSMAN
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16749 W GRACE ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-7659
Mailing Address - Country:US
Mailing Address - Phone:815-351-8622
Mailing Address - Fax:815-836-8612
Practice Address - Street 1:16749 W GRACE ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-7659
Practice Address - Country:US
Practice Address - Phone:815-351-8622
Practice Address - Fax:815-836-8612
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILEW69311098P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist