Healthcare Provider Details

I. General information

NPI: 1205956562
Provider Name (Legal Business Name): ELISE MAGERS M.DIV., L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E CHESTNUT ST
CHICAGO IL
60611-2014
US

IV. Provider business mailing address

55 E ERIE ST #3905
CHICAGO IL
60611-2798
US

V. Phone/Fax

Practice location:
  • Phone: 312-787-8425
  • Fax: 312-943-4459
Mailing address:
  • Phone: 312-654-8481
  • Fax: 312-654-9492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: