Provider Demographics
NPI:1073637658
Name:LONNQUIST, ELLEN M (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:M
Last Name:LONNQUIST
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 RIDGE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5918
Mailing Address - Country:US
Mailing Address - Phone:847-475-7003
Mailing Address - Fax:847-475-7333
Practice Address - Street 1:1740 RIDGE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5918
Practice Address - Country:US
Practice Address - Phone:847-475-7003
Practice Address - Fax:847-475-7333
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist