Provider Demographics
NPI:1962812123
Name:GENDELMAN, ELLEN SHERRI (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:SHERRI
Last Name:GENDELMAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14390 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1437
Mailing Address - Country:US
Mailing Address - Phone:248-968-1732
Mailing Address - Fax:
Practice Address - Street 1:14390 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1437
Practice Address - Country:US
Practice Address - Phone:248-968-1732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional