Provider Demographics
NPI:1013491265
Name:MCELRAVY, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MCELRAVY
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 1:239 COUNTY ROAD 1300 E
Mailing Address - Street 2:
Mailing Address - City:JEWETT
Mailing Address - State:IL
Mailing Address - Zip Code:62436-2301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:239 COUNTY ROAD 1300 E
Practice Address - Street 2:
Practice Address - City:JEWETT
Practice Address - State:IL
Practice Address - Zip Code:62436-2301
Practice Address - Country:US
Practice Address - Phone:217-663-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist