Individual
DR. ELLEN SOMBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
30 N MICHIGAN AVE, SUITE 506, CHICAGO, IL 60602-3402
(312) 346-1354
Mailing address
747 BELLEFORTE AVE, OAK PARK, IL 60302-1580
(708) 524-8631
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
71-4307
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001605401
BCBS ID NUMBER
IL
Enumeration date
04/04/2006
Last updated
07/08/2007
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