Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071010036 | IL |
Y | 103TC0700X | Clinical Psychologist | 071010036 | IL |
N | 103TH0004X | Health Psychologist |
NPI | 1619432812 |
---|---|
Provider Name | Elizabeth Laney Addington |
First Address | Chicago, IL 60611-2987 |
Second Address | Chicago, IL 60611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2019 |
Last Update Date | 20/06/2019 |