Provider Demographics
NPI:1942488416
Name:HOLPER, ELLEN MARY
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:HOLPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22W419 BALSAM DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-7305
Mailing Address - Country:US
Mailing Address - Phone:630-272-9351
Mailing Address - Fax:
Practice Address - Street 1:22W419 BALSAM DR
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-7305
Practice Address - Country:US
Practice Address - Phone:630-272-9351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist