Healthcare Provider Details

I. General information

NPI: 1679768485
Provider Name (Legal Business Name): ELIZABETH ANN ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 FINLEY RD STE 101
DOWNERS GROVE IL
60515-1394
US

IV. Provider business mailing address

2901 FINLEY RD STE 101
DOWNERS GROVE IL
60515-1394
US

V. Phone/Fax

Practice location:
  • Phone: 630-919-8218
  • Fax:
Mailing address:
  • Phone: 630-919-8218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number146008823
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: