Provider Demographics
NPI:1073186805
Name:EMILY GOODING APRN LLC
Entity Type:Organization
Organization Name:EMILY GOODING APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PSYCH OPS
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALENCIKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-363-2044
Mailing Address - Street 1:2500 W BRADLEY PL STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4716
Mailing Address - Country:US
Mailing Address - Phone:773-739-5600
Mailing Address - Fax:
Practice Address - Street 1:2500 W BRADLEY PL STE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4716
Practice Address - Country:US
Practice Address - Phone:773-739-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty