Organization
ELGIN WELL CHILD CONFERENCE
Active
Other names
Well Child Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRISHA ROTH MS.,RD.,LD. (EXECUTIVE DIRECTOR)
(847) 741-7340
Entity
Organization
Contact information
Practice address
620 WING ST, ELGIN, IL 60123-2800
(847) 741-7370
(847) 741-2413
Mailing address
620 WING ST, ELGIN, IL 60123-2800
(847) 741-7370
(847) 741-2413
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
237378349001
—
IL
Enumeration date
05/15/2007
Last updated
08/22/2020
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