Doctor Name: | DR. LYNN ELLEN NELSON |
NPI Number: | 1033447834 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 071004944 |
Business Practice Address: | 3330 Old Glenview Rd Suite 15 Wilmette, IL - 600912963 |
Business Phone Number: | 8472041557 |
Business Fax Number: | |
Mailing Address: | 3330 Old Glenview Rd, Suite 15 WILMETTE |
State: | IL |
Postal Code: | 600912963 |
Phone Number: | 8472041557 |
Fax Number: | |
NPI Enumeration Date: | 12/07/2009 |
NPI Last Update Date: | 12/07/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 071004944 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |