Provider Demographics
NPI:1891901906
Name:RUIZ, ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:RUIZ
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 1:53 W JACKSON BLVD
Mailing Address - Street 2:SUITE 804
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3493
Mailing Address - Country:US
Mailing Address - Phone:708-363-6960
Mailing Address - Fax:773-728-3788
Practice Address - Street 1:53 W JACKSON BLVD
Practice Address - Street 2:SUITE 804
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3493
Practice Address - Country:US
Practice Address - Phone:708-363-6960
Practice Address - Fax:773-728-3788
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005395103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical