Organization
ELLEN DIAMOND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANA MOSHKOVICH (CMM, CPC,CEMP)
(847) 904-7500
Entity
Organization
Contact information
Practice address
1866 SHERIDAN RD STE 207, HIGHLAND PARK, IL 60035-2545
(847) 433-3815
(847) 433-3203
Mailing address
1866 SHERIDAN RD STE 207, HIGHLAND PARK, IL 60035-2545
(847) 433-3815
(847) 433-3203
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071004187
IL
Other
Enumeration date
05/14/2012
Last updated
05/14/2012
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