Healthcare Provider Details

I. General information

NPI: 1992331813
Provider Name (Legal Business Name): FLOR ELDRIDGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11264 ROUTE 37
MARION IL
62959-8360
US

IV. Provider business mailing address

11264 ROUTE 37
MARION IL
62959-8360
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-2129
  • Fax: 618-997-7972
Mailing address:
  • Phone: 618-997-2129
  • Fax: 618-997-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.026604
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: