Provider Demographics
NPI:1306978903
Name:BENNEY, ELIZABETH (MA DT CIMI)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BENNEY
Suffix:
Gender:F
Credentials:MA DT CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 N CALIFORNIA AVE UNIT 47949
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-0360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2339 N CALIFORNIA AVE UNIT 47949
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-0360
Practice Address - Country:US
Practice Address - Phone:773-615-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILEB32530998P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILEB32530998POtherEI CREDENTIAL