Individual
ELLISE JEANNETTE BOYD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MAED
Contact information
Practice address
300 RUBY ST, JOLIET, IL 60435-6228
(708) 510-1287
Mailing address
300 RUBY ST, JOLIET, IL 60435-6228
(708) 510-1287
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
549055
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
549055
FAMILY AND PARENTING SUPPORT SERVICES
IL
Enumeration date
08/15/2019
Last updated
10/06/2022
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