Provider Demographics
NPI:1164646758
Name:COCHRAN, NANCY ELLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELLEN
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:ELLEN
Other - Last Name:FENZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1585 WOODCREST COURT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-1324
Mailing Address - Country:US
Mailing Address - Phone:630-375-9004
Mailing Address - Fax:
Practice Address - Street 1:507 THORNHILL DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188
Practice Address - Country:US
Practice Address - Phone:630-752-9750
Practice Address - Fax:630-752-9768
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008017103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical