Provider Demographics
NPI:1811061757
Name:ART, ELAINE FRANCES (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:FRANCES
Last Name:ART
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34076 N PRIMROSE CT
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-3499
Mailing Address - Country:US
Mailing Address - Phone:847-201-7269
Mailing Address - Fax:847-201-7269
Practice Address - Street 1:34076 N PRIMROSE CT
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-3499
Practice Address - Country:US
Practice Address - Phone:847-201-7269
Practice Address - Fax:847-201-7269
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932577OtherBLUE CROSS PROVIDER #