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General NPI Number Information
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NPI Number | 1538336193
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Entity Type | Individual
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Provider Name | ELNORA S JEFFERSON
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Gender | Female
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 5 REVERE DR STE 120
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City | NORTHBROOK
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State | IL
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Zip | 60062
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Country | US
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Telephone | 844-247-7222
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Fax |
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Provider Business Mailing Address
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Address Line | 2927 WILCOX AVE
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City | BELLWOOD
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State | IL
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Zip | 60104-2247
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Country | US
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Telephone | 615-478-9287
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 3704019
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 18-56015
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License Number State | IL
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