Provider Demographics
NPI:1689001182
Name:RODMAN, ELLEN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:RODMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 N LAKE SHORE DR APT 3B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3913
Mailing Address - Country:US
Mailing Address - Phone:773-732-0970
Mailing Address - Fax:
Practice Address - Street 1:401 S. LASALLE ST
Practice Address - Street 2:SUITE 1302D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605
Practice Address - Country:US
Practice Address - Phone:630-408-8108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18004260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional