Healthcare Provider Details

I. General information

NPI: 1801719992
Provider Name (Legal Business Name): ELEVATION PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26556 N 400 EAST RD
ANCONA IL
61311-9805
US

IV. Provider business mailing address

26556 N 400 EAST RD
ANCONA IL
61311-9805
US

V. Phone/Fax

Practice location:
  • Phone: 815-992-0376
  • Fax:
Mailing address:
  • Phone: 815-992-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CARISSA WOODDELL
Title or Position: OWNER/SPEECH LANGUAGE PATHOLOGIST
Credential: MS CCC-SLP
Phone: 815-992-0376