Provider Connections fax number

Fax destination details

Department

Center for Best Practices in Early Childhood Education, Western Illinois University

Purpose

Enrollment and billing submissions for Illinois Early Intervention; includes EI Service Matrix submissions, address/name changes, and related enrollment/billing updates.

Form

EI Service Matrix — EI Service Matrix Form

Address

Center for Best Practices in Early Childhood Education, Western Illinois University, 950 N Western Ave, Horrabin Hall, Room 20, Macomb, IL 61455

Voice phone

800-701-0995

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Download the EI Service Matrix, complete the required sections, and submit by mail or fax (not by email for sensitive changes). For name/address changes, include a typed list of affected providers with their NPIs; follow IMPACT and billing workflow guidance.