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General NPI Number Information
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NPI Number | 1720279722
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Entity Type | Individual
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Provider Name | ETHEL INA BARTKY M.S., LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 5225 OLD ORCHARD RD STE 6
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City | SKOKIE
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State | IL
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Zip | 60077-1027
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Country | US
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Telephone | 574-850-7465
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Fax |
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Provider Business Mailing Address
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Address Line | 2554 W MORSE AVE
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City | CHICAGO
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State | IL
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Zip | 60645-4606
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Country | US
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Telephone | 574-850-7465
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001267A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166001157
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License Number State | IL
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