Healthcare Provider Details

I. General information

NPI: 1538311964
Provider Name (Legal Business Name): ELIZABETH V. MICHAEL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2971 W ALGONQUIN RD SUITE 107A
ALGONQUIN IL
60102-9406
US

IV. Provider business mailing address

2971 W ALGONQUIN RD SUITE 107A
ALGONQUIN IL
60102-9406
US

V. Phone/Fax

Practice location:
  • Phone: 847-372-5046
  • Fax: 847-458-0071
Mailing address:
  • Phone: 847-372-5046
  • Fax: 847-458-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number071-0059-69
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-005969
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: