Provider Demographics
NPI:1225166721
Name:FIELD, ELLEN (DT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:FIELD
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3630
Mailing Address - Country:US
Mailing Address - Phone:847-707-4456
Mailing Address - Fax:847-459-7809
Practice Address - Street 1:678 MALLARD LN
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3630
Practice Address - Country:US
Practice Address - Phone:847-707-4456
Practice Address - Fax:847-459-7809
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL06521198P174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist