Provider Demographics
NPI:1508470774
Name:DR. ELOM AMUZU LLC
Entity Type:Organization
Organization Name:DR. ELOM AMUZU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELOM
Authorized Official - Middle Name:
Authorized Official - Last Name:AMUZU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-292-9753
Mailing Address - Street 1:18237 KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1411
Mailing Address - Country:US
Mailing Address - Phone:312-292-9753
Mailing Address - Fax:
Practice Address - Street 1:18237 KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1411
Practice Address - Country:US
Practice Address - Phone:708-299-0035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071010304OtherPROFESSIONAL LICENSE NO