Healthcare Provider Details

I. General information

NPI: 1902018732
Provider Name (Legal Business Name): BONNIE ELLENBOGEN LITOWITZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 NORTH MICHIGAN AVENUE SUITE 2220
CHICAGO IL
60601-7478
US

IV. Provider business mailing address

161 E CHICAGO AVENUE 46E
CHICAGO IL
60611-6680
US

V. Phone/Fax

Practice location:
  • Phone: 312-759-8130
  • Fax:
Mailing address:
  • Phone: 312-951-6310
  • Fax: 312-751-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number400
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: