Provider Demographics
NPI:1720279722
Name:BARTKY, ETHEL INA (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:INA
Last Name:BARTKY
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 W MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4606
Mailing Address - Country:US
Mailing Address - Phone:574-850-7465
Mailing Address - Fax:
Practice Address - Street 1:5225 OLD ORCHARD RD STE 6
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1027
Practice Address - Country:US
Practice Address - Phone:574-850-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001267A106H00000X
IL166001157106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35001267AOtherSTATE PROFESSIONAL LICENSING BUREAU