Individual
DR. RICHENEL SAMUEL ELLECOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D; DR.P.H
Contact information
Practice address
621 PLAINFIELD RD, SUITE 110, WILLOW BROOK, IL 60527-5343
(630) 654-1377
(630) 654-2575
Mailing address
621 PLAINFIELD RD, SUITE 110, WILLOW BROOK, IL 60527-5343
(630) 654-1377
(630) 654-2575
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
20040961A
IN
103G00000X
Clinical Neuropsychologist
71-5240
IL
133V00000X
Registered Dietitian
Primary
164-2611
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200078600
—
IN
05
—
200909210A
—
IN
Enumeration date
09/12/2005
Last updated
10/27/2008
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