Healthcare Provider Details

I. General information

NPI: 1992565410
Provider Name (Legal Business Name): JAYLA MARIE ELGIN CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 30TH ST BLDG 6M
DES MOINES IA
50310-5753
US

IV. Provider business mailing address

1361 NW JAMESTOWN LN
WAUKEE IA
50263-7207
US

V. Phone/Fax

Practice location:
  • Phone: 515-699-5999
  • Fax:
Mailing address:
  • Phone: 815-708-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number666208
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: