Healthcare Provider Details

I. General information

NPI: 1457368243
Provider Name (Legal Business Name): ELIZABETH RUTH HOLTZ M.SL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 01/25/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 N WASHINGTON ST
NAPERVILLE IL
60540-4512
US

IV. Provider business mailing address

132 N WASHINGTON ST
NAPERVILLE IL
60540-4512
US

V. Phone/Fax

Practice location:
  • Phone: 630-328-3420
  • Fax: 630-328-3407
Mailing address:
  • Phone: 630-328-3420
  • Fax: 630-328-3407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180002498
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-002498
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: