Healthcare Provider Details

I. General information

NPI: 1386128213
Provider Name (Legal Business Name): MS. JO ELLEN MAURER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WINDSOR DR STE 111
OAK BROOK IL
60523-4081
US

IV. Provider business mailing address

4780 SAINT JOSEPH CREEK RD APT 312
LISLE IL
60532-1831
US

V. Phone/Fax

Practice location:
  • Phone: 630-313-9741
  • Fax: 708-998-7029
Mailing address:
  • Phone: 630-899-9916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.014834
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: