Healthcare Provider Details

I. General information

NPI: 1922192772
Provider Name (Legal Business Name): ELIZABETH THOMPSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 MASON LN
LAKE IN THE HILLS IL
60156-4458
US

IV. Provider business mailing address

841 MASON LN
LAKE IN THE HILLS IL
60156-4458
US

V. Phone/Fax

Practice location:
  • Phone: 847-344-5858
  • Fax: 847-253-4597
Mailing address:
  • Phone: 847-344-5858
  • Fax: 847-253-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071003390
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1843
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number071003390
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071003390
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: