Healthcare Provider Details

I. General information

NPI: 1619939865
Provider Name (Legal Business Name): ELLEN SOMBERG PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LAKE ST
OAK PARK IL
60301-1015
US

IV. Provider business mailing address

747 BELLEFORTE AVE
OAK PARK IL
60302-1580
US

V. Phone/Fax

Practice location:
  • Phone: 312-346-1354
  • Fax:
Mailing address:
  • Phone: 708-524-8631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number71-4307
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: