Healthcare Provider Details

I. General information

NPI: 1134895196
Provider Name (Legal Business Name): EWA ZOFIA EHRLICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 OAK PARK AVE
BERWYN IL
60402-3429
US

IV. Provider business mailing address

241 WASHINGTON BLVD APT 2A
OAK PARK IL
60302-4137
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-7490
  • Fax:
Mailing address:
  • Phone: 847-331-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277005061
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: