Provider Demographics
NPI:1245569268
Name:ODONOHUE, ERIN M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:M
Last Name:ODONOHUE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:M
Other - Last Name:OMALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4160 RFD STE 307
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-9586
Mailing Address - Country:US
Mailing Address - Phone:630-235-5876
Mailing Address - Fax:
Practice Address - Street 1:4160 RFD STE 307
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-9586
Practice Address - Country:US
Practice Address - Phone:630-235-5876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007909103TC0700X
IL178.006421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional