Healthcare Provider Details

I. General information

NPI: 1174468359
Provider Name (Legal Business Name): NADA ELHAJOMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W GEORGE ST # A
CHICAGO IL
60657-5032
US

IV. Provider business mailing address

1070 N PAULINA ST
CHICAGO IL
60622-3869
US

V. Phone/Fax

Practice location:
  • Phone: 608-220-7568
  • Fax:
Mailing address:
  • Phone: 614-679-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.008445
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: