Provider Demographics
NPI:1053442616
Name:INGRAM, ELLEN WHITNEY (DT)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:WHITNEY
Last Name:INGRAM
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1632
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-6010
Mailing Address - Country:US
Mailing Address - Phone:847-948-8578
Mailing Address - Fax:847-948-8578
Practice Address - Street 1:1466 CROWE AVE
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-2120
Practice Address - Country:US
Practice Address - Phone:847-948-8578
Practice Address - Fax:847-948-8578
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist