Ellise Jeannette Boyd, MAED

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

549055 Issued in IL

Practice address

300 Ruby St
Joliet, IL 60435-6228

Phone

(708) 510-1287

NPI assigned

Aug 15, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1811543713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 RUBY ST",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604356228",
            "telephone_number": "708-510-1287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 RUBY ST",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604356228",
            "telephone_number": "708-510-1287"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "407 W Jefferson St Ste E",
            "address_purpose": "LOCATION",
            "city": "Joliet",
            "state": "IL",
            "postal_code": "604357471",
            "country_code": "US",
            "telephone_number": "815-409-7444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOYD",
        "first_name": "ELLISE",
        "middle_name": "JEANNETTE",
        "credential": "MAED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-15",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "IL",
            "license": "549055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY AND PARENTING SUPPORT SERVICES",
            "identifier": "549055",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHILD CARE INSTITUTION",
            "identifier": "549055",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Bosh, LSW
• Allison Marie Bouma
• Brian Bouton, OD
• Shannon Abel Bowles, R.N.
• Megan Bowman, SSP
• Jessica L Boyd, PT
• Joanne Boyd
• Rachel Brace
• Demitrius Brackett, OWNER/DO
• Kim Katherine Bradley

• Community Health Worker in Joliet, IL
• Providers in Joliet, IL by specialty
• Community Health Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.