1669550240 NPI number — MRS. ELIA OLIVARES M.S., CCC

Table of content: MRS. ELIA OLIVARES M.S., CCC (NPI 1669550240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669550240 NPI number — MRS. ELIA OLIVARES M.S., CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLIVARES
Provider First Name:
ELIA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARCIA
Provider Other First Name:
ELIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669550240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
412 JAMESTOWN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60502-6473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-375-0756
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 LACEY RD
Provider Second Line Business Practice Location Address:
NORTHERN ILLINOIS UNIV. SPEECH-LANGUAGE-HEARING CLINIC
Provider Business Practice Location Address City Name:
DOWNERS GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60515-5430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-743-4500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  146.006157 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)