Active NPI
Eliana Green
- Speech-Language Pathologist
- Chicago, IL
National Provider Identifier
1083164362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 242004238
- Practice address
- 1957 W Dickens Ave
Chicago, IL 60614-3934 - Phone
- (773) 789-9640
- NPI assigned
- Oct 10, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 242004238 | IL | Primary |
Addresses
Primary practice location
1957 W Dickens Ave
Chicago, IL 60614-3934
Mailing address
3400 N Lake Shore Dr Apt 1C
Chicago, IL 60657-2802
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 242004238 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476057600000",
"number": "1083164362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 N LAKE SHORE DR APT 1C",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606572802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1957 W DICKENS AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606143934",
"telephone_number": "773-789-9640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "ELIANA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-10",
"last_updated": "2016-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "242004238",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.