Provider Demographics
NPI:1306995915
Name:HAAS, ELLEN M (PHD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:HAAS
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 1:10217 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1279
Mailing Address - Country:US
Mailing Address - Phone:815-277-7792
Mailing Address - Fax:815-463-8252
Practice Address - Street 1:10217 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1279
Practice Address - Country:US
Practice Address - Phone:815-277-7792
Practice Address - Fax:815-463-8252
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006202103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist