Healthcare Provider Details

I. General information

NPI: 1982515573
Provider Name (Legal Business Name): ELLIE JEE MIN BARTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 OZIER DR
BATAVIA IL
60510-1393
US

IV. Provider business mailing address

530 OZIER DR
BATAVIA IL
60510-1393
US

V. Phone/Fax

Practice location:
  • Phone: 630-715-5348
  • Fax:
Mailing address:
  • Phone: 630-715-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberB630-2100-3868
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: