Provider Demographics
NPI:1427257260
Name:GRIFFIN, ELLEN M (PSYD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:GRIFFIN
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 1:155 N. MICHIGAN AVE.
Mailing Address - Street 2:SUITE 512
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7612
Mailing Address - Country:US
Mailing Address - Phone:312-787-2726
Mailing Address - Fax:
Practice Address - Street 1:155 N. MICHIGAN AVE.
Practice Address - Street 2:SUITE 512
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7612
Practice Address - Country:US
Practice Address - Phone:312-787-2726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005626103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical