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NPI Code Detail

MEDICARE: MARISSA MCELLIGOTT

MEDICARE: MARISSA MCELLIGOTT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-24-353910IL

General Provider Information

NPI Number : 1063237204
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISSA MCELLIGOTT
Provider Business Mailing Address
First Line : 16415 DEER RUN DR
Second Line :
City : LOCKPORT
State : IL
Zip : 60441-4783
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 522 W CHESTNUT ST STE GA
Second Line :
City : HINSDALE
State : IL
Zip : 60521-3174
Country : US
Telephone Number : 331-271-5070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2024
Last Update Date : 11/26/2024

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Directions to “ MARISSA MCELLIGOTT ” Practice Location

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