Provider Demographics
NPI:1285806356
Name:DRIVER, ELLYN JOYCE
Entity type:Individual
Prefix:
First Name:ELLYN
Middle Name:JOYCE
Last Name:DRIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-1027
Mailing Address - Country:US
Mailing Address - Phone:217-483-4453
Mailing Address - Fax:
Practice Address - Street 1:30 PARTRIDGE DR
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-1027
Practice Address - Country:US
Practice Address - Phone:217-483-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-29
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency