Healthcare Provider Details

I. General information

NPI: 1790319226
Provider Name (Legal Business Name): ELLEN HOTCHKISS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WOOD CT
WILMETTE IL
60091-3328
US

IV. Provider business mailing address

240 WOOD CT
WILMETTE IL
60091-3328
US

V. Phone/Fax

Practice location:
  • Phone: 847-712-1829
  • Fax:
Mailing address:
  • Phone: 847-712-1829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.021970
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: