Healthcare Provider Details

I. General information

NPI: 1336240761
Provider Name (Legal Business Name): ROBIN L. ELAM M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W JEFFERSON AVE
ALTAMONT IL
62411-1311
US

IV. Provider business mailing address

707 W JEFFERSON AVE
ALTAMONT IL
62411-1311
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-7179
  • Fax:
Mailing address:
  • Phone: 217-347-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: