Provider Demographics
NPI:1205659927
Name:ELMORE, DORI LEE
Entity type:Individual
Prefix:
First Name:DORI
Middle Name:LEE
Last Name:ELMORE
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 1:18409 COWING CT
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3334
Mailing Address - Country:US
Mailing Address - Phone:217-454-2985
Mailing Address - Fax:
Practice Address - Street 1:18409 COWING CT
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3334
Practice Address - Country:US
Practice Address - Phone:217-454-2985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 252Y00000X
IL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No171W00000XOther Service ProvidersContractor