Doctor Name: | ELLEN LOCKE |
NPI Number: | 1174910632 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 149-004535 |
Business Practice Address: | 1000 N Wolf Rd Northlake, IL - 601641438 |
Business Phone Number: | 8476440896 |
Business Fax Number: | |
Mailing Address: | 1005 Meadow Ln, ELGIN |
State: | IL |
Postal Code: | 601231429 |
Phone Number: | 8476440896 |
Fax Number: | |
NPI Enumeration Date: | 04/22/2015 |
NPI Last Update Date: | 04/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041S0200X |
License Number: | 149-004535 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | School |
Taxonomy Definition: |