=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558915975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENVIRONMENTAL HEALTH RESEARCH ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2019
-----------------------------------------------------
Last Update Date | 05/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 W GALENA BLVD
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60506-4025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-896-8321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1N544 BOBOLINK DR.
-----------------------------------------------------
City | WINFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-690-5420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF LYMPHATIC CLINICIAN
-----------------------------------------------------
Name | DR. SYLVIA WASHINGTON
-----------------------------------------------------
Credential | PHD,ND,MPH, CLT-LANA
-----------------------------------------------------
Telephone | 630-690-5420
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------