Provider Demographics
NPI:1871654178
Name:SCHALLACK, ELIZABETH (LCPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SCHALLACK
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 1:539 BELLEFORTE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1623
Mailing Address - Country:US
Mailing Address - Phone:630-567-8141
Mailing Address - Fax:
Practice Address - Street 1:642 S LOMBARD AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1606
Practice Address - Country:US
Practice Address - Phone:630-567-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006139101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional