MEDICARE: ELIZABETH M. BOLASH, PSY.D., PC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		IL

General Provider Information

NPI Number	:	1437104403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH M. BOLASH, PSY.D., PC

Provider Business Mailing Address
First Line	:	115 S WILKE RD
Second Line	:	SUITE 300
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1532
Country	:	US
Telephone Number	:	847-259-2020
Fax Number	:	847-259-2078

Provider Business Practice Location Address
First Line	:	115 S WILKE RD
Second Line	:	SUITE 300
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1532
Country	:	US
Telephone Number	:	847-259-2020
Fax Number	:	847-259-2078

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. ELIZABETH M BOLASH
Credential	:	PSY.D.
Telephone Number	:	847-259-2020

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/22/2020

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