Individual
DR. RUSSELL ELLEVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMIN, EDD
Contact information
Practice address
201 S STEWART AVE, LIBERTYVILLE, IL 60048-2743
(312) 330-5353
Mailing address
201 S STEWART AVE, LIBERTYVILLE, IL 60048-2743
(312) 330-5353
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
36465
IL
Other
Enumeration date
02/26/2021
Last updated
02/26/2021
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