Healthcare Provider Details

I. General information

NPI: 1114653110
Provider Name (Legal Business Name): ELI ANITA ARDRON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 N LAKEWOOD AVE
CHICAGO IL
60657-3215
US

IV. Provider business mailing address

1912 N SPAULDING AVE APT 2
CHICAGO IL
60647-4991
US

V. Phone/Fax

Practice location:
  • Phone: 312-279-9981
  • Fax: 312-279-9981
Mailing address:
  • Phone: 208-921-8349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number1750668091
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.001566
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: