Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 071.009515 | IL |
N | 103T00000X | Psychologist | 071.009515 | IL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 071.009515 | IL |
Y | 103G00000X | Clinical Psychologist | 071.009515 | IL |
Y | 103TC0700X | Clinical Psychologist | 071.009515 | IL |
N | 103TH0004X | Health Psychologist | 071.009515 | IL |
N | 103TP2701X | Group Psychotherapist | 071.009515 | IL |
NPI | 1063075141 |
---|---|
Provider Name | Dr. Ellen Jorstad-Stein |
First Address | Hinsdale, IL 60521-3184 |
Second Address | Hinsdale, IL 60521-3184 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2019 |
Last Update Date | 18/12/2019 |