Healthcare Provider Details

I. General information

NPI: 1740638915
Provider Name (Legal Business Name): ELIZABETH REGINA TUMINELLO HARTMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ELIZABETH REGINA TUMINELLO

II. Dates (important events)

Enumeration Date: 05/29/2016
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST STE 520
PARK RIDGE IL
60068-1130
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-720-6464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071009302
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: