Provider Demographics
NPI:1215747662
Name:COOPER-TAILLANDIER, ELLAINE (LSW)
Entity type:Individual
Prefix:
First Name:ELLAINE
Middle Name:
Last Name:COOPER-TAILLANDIER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 SANDGATE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2306
Mailing Address - Country:US
Mailing Address - Phone:818-441-4756
Mailing Address - Fax:
Practice Address - Street 1:55 S MAIN ST STE 252
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5576
Practice Address - Country:US
Practice Address - Phone:630-238-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.114581104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker