Provider Demographics
NPI:1356556344
Name:KUMKOVA, ELENA I (PHD)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:I
Last Name:KUMKOVA
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 1:3930 N PINE GROVE AVE
Mailing Address - Street 2:UNIT 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3346
Mailing Address - Country:US
Mailing Address - Phone:773-531-0718
Mailing Address - Fax:
Practice Address - Street 1:8021 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3611
Practice Address - Country:US
Practice Address - Phone:847-568-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist