MEDICARE: CHRISTOPHER ELLWOOD

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	101YP2500X	Professional Counselor	178.014915	IL

General Provider Information

NPI Number	:	1558923128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER ELLWOOD

Provider Business Mailing Address
First Line	:	21 KRISTIN DR UNIT 317
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60195-3333
Country	:	US
Telephone Number	:	630-336-8949
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 EXECUTIVE CT STE 5
Second Line	:
City	:	SOUTH BARRINGTON
State	:	IL
Zip	:	60010-9551
Country	:	US
Telephone Number	:	224-655-2487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	07/14/2019

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