Basic Information
| Provider Information | |||||||||
| NPI: | 1558761882 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ELGIN | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 DES PLAINES AVE | ||||||||
| Address2: | |||||||||
| City: | FOREST PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601302035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083662442 | ||||||||
| FaxNumber: | 7083660179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2014 | ||||||||
| LastUpdateDate: | 08/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.