Provider Demographics
NPI:1558374157
Name:COE, ELEANOR B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:B
Last Name:COE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N. WABASH AVE
Mailing Address - Street 2:SUITE 1422
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1903
Mailing Address - Country:US
Mailing Address - Phone:312-236-7997
Mailing Address - Fax:312-236-6711
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:SUITE 1422
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1903
Practice Address - Country:US
Practice Address - Phone:312-236-7997
Practice Address - Fax:312-236-6711
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL222210Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST