| Ellis Clinical Services Llc | |
|
2635 S Wabash Ave Fl 3 Chicago IL 60616 | |
| (773) 377-6141 | |
| Not Available |
| Full Name | Ellis Clinical Services Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2635 S Wabash Ave Fl 3, Chicago, Illinois |
| Authorized Official Name and Position | Nicola Ellis (OWNER) |
| Authorized Official Contact | 7737937147 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellis Clinical Services Llc Po Box 361 Berwyn IL 60402-0361 Ph: (773) 377-6141 | Ellis Clinical Services Llc 2635 S Wabash Ave Fl 3 Chicago IL 60616 Ph: (773) 377-6141 |
| NPI Number | 1114437399 |
|---|---|
| Provider Enumeration Date | 10/02/2017 |
| Last Update Date | 05/13/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114437399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149018206 (Illinois) | Primary |
| 1041C0700X | Social Worker - Clinical | C008340 (North Carolina) | Secondary |
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