Provider Demographics
NPI:1114947694
Name:LITZ, NANCY J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:LITZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 S PARK BLVD
Mailing Address - Street 2:SUITE 355
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6280
Mailing Address - Country:US
Mailing Address - Phone:630-469-6697
Mailing Address - Fax:630-665-7701
Practice Address - Street 1:45 S PARK BLVD
Practice Address - Street 2:SUITE 355
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6280
Practice Address - Country:US
Practice Address - Phone:630-469-6697
Practice Address - Fax:630-665-7701
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00452352OtherRAIL ROAD MEDICARE
IL2232634OtherBCBS
ILP00452352OtherRAIL ROAD MEDICARE