Provider Demographics
NPI:1437104403
Name:ELIZABETH M. BOLASH, PSY.D., PC
Entity Type:Organization
Organization Name:ELIZABETH M. BOLASH, PSY.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOLASH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-259-2020
Mailing Address - Street 1:115 S WILKE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1532
Mailing Address - Country:US
Mailing Address - Phone:847-259-2020
Mailing Address - Fax:847-259-2078
Practice Address - Street 1:115 S WILKE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1532
Practice Address - Country:US
Practice Address - Phone:847-259-2020
Practice Address - Fax:847-259-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)