Provider Demographics
NPI:1114685518
Name:MIKHAIL, EMILY RUTH
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RUTH
Last Name:MIKHAIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-982-6715
Mailing Address - Fax:847-982-3394
Practice Address - Street 1:2740 W FOSTER AVE STE 113
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3547
Practice Address - Country:US
Practice Address - Phone:773-293-5300
Practice Address - Fax:773-293-5346
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490242651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical