MEDICARE: ELIZABETH WONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1588423537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH WONG

Provider Business Mailing Address
First Line	:	11780 BORMAN DR STE 400
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4135
Country	:	US
Telephone Number	:	314-275-0506
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 N LA SALLE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-6000
Country	:	US
Telephone Number	:	312-248-1801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	12/03/2025

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Directions to “ ELIZABETH WONG ” Practice Location

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