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General NPI Number Information
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NPI Number | 1609710730
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Entity Type | Organization
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Legal Business Name | ELITE IMPACT LLC
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Dates
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Enumeration Date | 04/17/2026
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Last Update Date | 04/17/2026
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Provider Practice Location Address
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Address Line | 7610 S MAY ST. APT.1
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City | CHICAGO
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State | IL
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Zip | 60620
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Country | US
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Telephone | 708-466-9716
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Fax |
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Provider Business Mailing Address
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Address Line | 10735 S WESTERN AVE STE 6 #234
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City | CHICAGO
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State | IL
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Zip | 60643
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Country | US
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Telephone | 708-466-9716
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STACIE FRAZIER
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Credential |
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Telephone | 708-466-9716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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