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NPI Code Detail

MEDICARE: DR. ELIZABETH M BOLASH PSY.D.

MEDICARE:  DR. ELIZABETH M BOLASH  PSY.D.
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
1103TC0700XClinical PsychologistIL

General Provider Information

NPI Number : 1841239043
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH M BOLASH PSY.D.
Provider Business Mailing Address
First Line : 2104 GEORGE ST
Second Line :
City : ROLLING MEADOWS
State : IL
Zip : 60008-1702
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 07/08/2007

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