Healthcare Provider Details

I. General information

NPI: 1225518053
Provider Name (Legal Business Name): CLARISSA VON MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N COUNTY FARM RD
WHEATON IL
60187-3977
US

IV. Provider business mailing address

320 MIDDLETREE RD
JOLIET IL
60433-2973
US

V. Phone/Fax

Practice location:
  • Phone: 630-682-7400
  • Fax:
Mailing address:
  • Phone: 815-630-1653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: