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General NPI Number Information
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NPI Number | 1063533156
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Entity Type | Individual
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Provider Name | HELENE RITA ELLIS L.C.S.W., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3330 OLD GLENVIEW RD SUITE 15
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City | WILMETTE
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State | IL
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Zip | 60091-2963
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Country | US
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Telephone | 847-800-4408
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Fax |
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Provider Business Mailing Address
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Address Line | 2530 WELLINGTON CT
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City | EVANSTON
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State | IL
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Zip | 60201-4975
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Country | US
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Telephone | 847-475-4407
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Fax | 847-475-4420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | IL
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