Healthcare Provider Details

I. General information

NPI: 1982955746
Provider Name (Legal Business Name): MS. ELOISE LYNELLE PITTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7335 S ABERDEEN ST
CHICAGO IL
60621-1022
US

IV. Provider business mailing address

7335 S ABERDEEN ST
CHICAGO IL
60621-1022
US

V. Phone/Fax

Practice location:
  • Phone: 773-656-3073
  • Fax:
Mailing address:
  • Phone: 773-656-3073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number222Q00000X
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: