Healthcare Provider Details

I. General information

NPI: 1942814934
Provider Name (Legal Business Name): ELYSA BOND MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 09/07/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 809
CHICAGO IL
60612-3861
US

IV. Provider business mailing address

1725 W HARRISON ST STE 809
CHICAGO IL
60612-3861
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5904
  • Fax: 312-947-3090
Mailing address:
  • Phone: 312-947-5344
  • Fax: 312-947-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number247.000150
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: