Healthcare Provider Details

I. General information

NPI: 1700705167
Provider Name (Legal Business Name): LOTTIE ALIVIA, ELIZABETH TODD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 3RD ST
CHARLESTON IL
61920-2639
US

IV. Provider business mailing address

905 3RD ST
CHARLESTON IL
61920-2639
US

V. Phone/Fax

Practice location:
  • Phone: 217-254-5838
  • Fax:
Mailing address:
  • Phone: 217-254-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: