Individual
MISS ELLEN KOUCKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
820 S DAMEN AVE, CHICAGO, IL 60612-3728
(708) 990-5295
Mailing address
820 S DAMEN AVE, CHICAGO, IL 60612-3728
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.009048
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/17/2012
Last updated
10/18/2022
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