Provider Demographics
NPI:1174654990
Name:KOLLMORGEN, LIZABETH A (PSYD)
Entity Type:Individual
Prefix:
First Name:LIZABETH
Middle Name:A
Last Name:KOLLMORGEN
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 1:910 SKOKIE BLVD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4032
Mailing Address - Country:US
Mailing Address - Phone:847-480-9999
Mailing Address - Fax:
Practice Address - Street 1:910 SKOKIE BLVD.
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4032
Practice Address - Country:US
Practice Address - Phone:847-480-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21620045OtherBCBS OF IL PROVIDER ID
IL211816Medicare ID - Type UnspecifiedGROUP #