Provider Demographics
NPI:1184849945
Name:ROUTTENBERG, ELLIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLIE
Middle Name:
Last Name:ROUTTENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 DAVIS ST UNIT 309
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4767
Mailing Address - Country:US
Mailing Address - Phone:847-814-7328
Mailing Address - Fax:847-814-7328
Practice Address - Street 1:425 DAVIS ST UNIT 309
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4767
Practice Address - Country:US
Practice Address - Phone:847-814-7328
Practice Address - Fax:847-814-7328
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490030111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL97073Medicare ID - Type UnspecifiedCOOK COUNTY (453780 GRP#)
IL322110Medicare ID - Type Unspecified
ILR16599Medicare UPIN
ILL97072Medicare ID - Type UnspecifiedLAKE COUNTY (200994 GRP#)
ILK51860Medicare PIN
ILK51861Medicare PIN