Provider Demographics
NPI:1730415373
Name:ELSBERG, CAROLYN MAZUR (BS ECE)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MAZUR
Last Name:ELSBERG
Suffix:
Gender:F
Credentials:BS ECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 N SPRINGFIELD AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5110
Mailing Address - Country:US
Mailing Address - Phone:847-207-0625
Mailing Address - Fax:
Practice Address - Street 1:3240 N SPRINGFIELD AVE
Practice Address - Street 2:APT. 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5110
Practice Address - Country:US
Practice Address - Phone:847-207-0625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-01
Last Update Date:2009-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist