Provider Demographics
NPI:1235891730
Name:ELMELIGI, BASSMA
Entity type:Individual
Prefix:
First Name:BASSMA
Middle Name:
Last Name:ELMELIGI
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 1:1389 PARKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8695
Mailing Address - Country:US
Mailing Address - Phone:181-570-1485
Mailing Address - Fax:
Practice Address - Street 1:118 BARRINGTON COMMONS CT
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3297
Practice Address - Country:US
Practice Address - Phone:847-660-6706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker