Provider Demographics
NPI:1760529861
Name:ALTER, ELLEN SACHS (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:SACHS
Last Name:ALTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 WILMETTE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2643
Mailing Address - Country:US
Mailing Address - Phone:847-447-6711
Mailing Address - Fax:
Practice Address - Street 1:1167 WILMETTE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2643
Practice Address - Country:US
Practice Address - Phone:847-447-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical