Provider Demographics
NPI:1669943635
Name:YUNG, ELLA AMANDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELLA
Middle Name:AMANDA
Last Name:YUNG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N LAKE SHORE DR APT 1802
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4908
Mailing Address - Country:US
Mailing Address - Phone:317-750-4878
Mailing Address - Fax:
Practice Address - Street 1:3100 N LAKE SHORE DR APT 1802
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4908
Practice Address - Country:US
Practice Address - Phone:317-750-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009924103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical