Healthcare Provider Details

I. General information

NPI: 1407235526
Provider Name (Legal Business Name): ELYSE FELDMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 901
CHICAGO IL
60602-3767
US

IV. Provider business mailing address

843 W CASTLEWOOD TER
CHICAGO IL
60640-4216
US

V. Phone/Fax

Practice location:
  • Phone: 773-789-8934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: