Provider Demographics
NPI:1740087923
Name:VINOGRADOVA, ELENA
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:VINOGRADOVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 MURIEL CT
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5918
Mailing Address - Country:US
Mailing Address - Phone:224-803-7830
Mailing Address - Fax:
Practice Address - Street 1:405 MURIEL CT
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5918
Practice Address - Country:US
Practice Address - Phone:224-803-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.021305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional