Provider Demographics
NPI:1316645807
Name:CROOK, EMILY RENEE (EDS)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:RENEE
Last Name:CROOK
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 W DRUMMOND PL APT 3B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1267
Mailing Address - Country:US
Mailing Address - Phone:847-345-9636
Mailing Address - Fax:
Practice Address - Street 1:8000 E PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3402
Practice Address - Country:US
Practice Address - Phone:847-676-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2480862103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool