Provider Demographics
NPI:1760941785
Name:MIDDLEBROOK, ELIZABETH ANNE (SSP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:MIDDLEBROOK
Suffix:
Gender:F
Credentials:SSP
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:SAWKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SSP
Mailing Address - Street 1:7 HEATHER HL
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1622
Mailing Address - Country:US
Mailing Address - Phone:815-823-5627
Mailing Address - Fax:
Practice Address - Street 1:7 HEATHER HL
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1622
Practice Address - Country:US
Practice Address - Phone:815-823-5627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool