Individual
MARSHALL ELLIOTT KORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
5100 N RAVENSWOOD AVE STE 239, CHICAGO, IL 60640-1752
(773) 267-3703
(773) 267-3703
Mailing address
5100 N RAVENSWOOD AVE STE 239, CHICAGO, IL 60640-1752
(773) 267-3703
(773) 267-3703
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.005308
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621915
BLUE CROSS BLUE SHIELD
IL
01
—
364256529
UNITED BEHAVIORAL HEALTH
IL
Enumeration date
07/12/2006
Last updated
07/07/2021
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