Provider Demographics
NPI:1174860928
Name:ELIAS, ROSE F (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:F
Last Name:ELIAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 N KEDZIE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2477
Mailing Address - Country:US
Mailing Address - Phone:773-754-0577
Mailing Address - Fax:
Practice Address - Street 1:4141 N KEDZIE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-2477
Practice Address - Country:US
Practice Address - Phone:773-754-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008492103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical