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General NPI Number Information
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NPI Number | 1326118472
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Entity Type | Individual
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Provider Name | ELIZABETH J. SIMON-ROPER LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 4180 STATE HIGHWAY 83 SUITE 204
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City | LONG GROVE
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State | IL
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Zip | 60047
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Country | US
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Telephone | 224-688-8167
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Fax | 847-356-5470
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Provider Business Mailing Address
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Address Line | 38735 N MUNN RD
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City | LAKE VILLA
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State | IL
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Zip | 60046-7764
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Country | US
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Telephone | 847-356-5470
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Fax |
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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 | 149-002458
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2412-123
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License Number State | WI
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