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General NPI Number Information
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NPI Number | 1306995915
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Entity Type | Individual
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Provider Name | ELLEN M HAAS PHD
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 10217 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1279
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Country | US
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Telephone | 815-277-7792
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Fax | 815-463-8252
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Provider Business Mailing Address
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Address Line | 10217 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1279
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Country | US
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Telephone | 815-277-7792
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Fax | 815-463-8252
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071.006202
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License Number State | IL
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