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NPI Code Detail

MEDICARE: ELLEN M HAAS PHD

MEDICARE:   ELLEN M HAAS  PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist071.006202IL

General Provider Information

NPI Number : 1306995915
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN M HAAS PHD
Provider Business Mailing Address
First Line : 10217 W LINCOLN HWY
Second Line :
City : FRANKFORT
State : IL
Zip : 60423-1279
Country : US
Telephone Number : 815-277-7792
Fax Number : 815-463-8252
Provider Business Practice Location Address
First Line : 10217 W LINCOLN HWY
Second Line :
City : FRANKFORT
State : IL
Zip : 60423-1279
Country : US
Telephone Number : 815-277-7792
Fax Number : 815-463-8252
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 06/13/2012

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Directions to “ ELLEN M HAAS PHD” Practice Location

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