Healthcare Provider Details

I. General information

NPI: 1760668727
Provider Name (Legal Business Name): NANCY J LITZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 S PARK BLVD STE 355
GLEN ELLYN IL
60137-6283
US

IV. Provider business mailing address

45 S PARK BLVD STE 355
GLEN ELLYN IL
60137-6283
US

V. Phone/Fax

Practice location:
  • Phone: 630-469-6697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name: TINA BOMBARD
Title or Position: BILLING MANAGER
Credential:
Phone: 630-897-6851