Healthcare Provider Details

I. General information

NPI: 1144255522
Provider Name (Legal Business Name): ELLEN HURST-ELLIOT M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29W522 BATAVIA RD
WARRENVILLE IL
60555-2007
US

IV. Provider business mailing address

1960 LYNDHURST LN
AURORA IL
60503-8515
US

V. Phone/Fax

Practice location:
  • Phone: 630-988-2812
  • Fax: 630-566-1622
Mailing address:
  • Phone: 630-988-2812
  • Fax: 630-566-1622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: