Healthcare Provider Details

I. General information

NPI: 1669757720
Provider Name (Legal Business Name): ELIZABETH STRAKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 AURORA DR UNIT 8
PINGREE GROVE IL
60140-6439
US

IV. Provider business mailing address

2275 AURORA DR UNIT 8
PINGREE GROVE IL
60140-6439
US

V. Phone/Fax

Practice location:
  • Phone: 847-975-6213
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: