=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235891730
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BASSMA ELMELIGI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2021
-----------------------------------------------------
Last Update Date | 10/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 BARRINGTON COMMONS CT
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60010-3297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-660-6706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1389 PARKRIDGE DR
-----------------------------------------------------
City | CRYSTAL LAKE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60014-8695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 181-570-1485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------