Provider Demographics
NPI:1467868729
Name:WOOD, ELYSE N (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:N
Last Name:WOOD
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MISS
Other - First Name:ELYSE
Other - Middle Name:N
Other - Last Name:DOMBROWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, AMFT
Mailing Address - Street 1:131 YUMA LN
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1916
Mailing Address - Country:US
Mailing Address - Phone:630-890-1194
Mailing Address - Fax:
Practice Address - Street 1:640 N RIVER RD STE 108
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8947
Practice Address - Country:US
Practice Address - Phone:630-718-0717
Practice Address - Fax:630-718-0747
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000351106H00000X
IL166001075106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist