Individual
KHALIAH YVONNE ELLISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1629 CHICAGO AVE, EVANSTON, IL 60201-4504
(773) 297-1023
Mailing address
6111 S DREXEL AVE, CHICAGO, IL 60637-2627
(773) 297-1023
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.004400
IL
Other
Enumeration date
02/25/2017
Last updated
02/25/2017
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