Healthcare Provider Details

I. General information

NPI: 1003054818
Provider Name (Legal Business Name): MS. ELIZABETH JOANNE COPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11351 S BELMONT DR
PLAINFIELD IL
60585-6136
US

IV. Provider business mailing address

11351 S BELMONT DR
PLAINFIELD IL
60585-6136
US

V. Phone/Fax

Practice location:
  • Phone: 630-805-0368
  • Fax: 630-257-2057
Mailing address:
  • Phone: 630-805-0368
  • Fax: 630-257-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number2239933
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: