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General NPI Number Information
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NPI Number | 1013570100
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Entity Type | Individual
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Provider Name | ELIZABETH MARIE PHILLIPS MS, CCC-SLP/L
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Gender | Female
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 2132 W JEFFERSON ST
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City | JOLIET
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State | IL
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Zip | 60435-6622
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Country | US
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Telephone | 817-741-7114
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Fax |
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Provider Business Mailing Address
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Address Line | 713 PLEASANT CT
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City | SHOREWOOD
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State | IL
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Zip | 60404-9578
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Country | US
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Telephone | 815-354-6118
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.014479
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License Number State | IL
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