Provider Demographics
NPI:1386128213
Name:MAURER, JO ELLEN
Entity type:Individual
Prefix:MS
First Name:JO ELLEN
Middle Name:
Last Name:MAURER
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 1:4780 SAINT JOSEPH CREEK RD APT 312
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1831
Mailing Address - Country:US
Mailing Address - Phone:630-899-9916
Mailing Address - Fax:
Practice Address - Street 1:125 WINDSOR DR STE 111
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4081
Practice Address - Country:US
Practice Address - Phone:630-313-9741
Practice Address - Fax:708-998-7029
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health