Provider Demographics
NPI:1336375989
Name:NELSON, EDWIN CARL
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:CARL
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 N RANDALL RD
Mailing Address - Street 2:STE 110
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7877
Mailing Address - Country:US
Mailing Address - Phone:847-741-2818
Mailing Address - Fax:847-741-8694
Practice Address - Street 1:1530 N RANDALL RD
Practice Address - Street 2:STE 110
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7877
Practice Address - Country:US
Practice Address - Phone:847-741-2818
Practice Address - Fax:847-741-8694
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2909237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist