Provider Demographics
NPI:1871240705
Name:EZZO, EMILY E (PSYD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:E
Last Name:EZZO
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 1:5225 OLD ORCHARD RD STE 23A
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4406
Mailing Address - Country:US
Mailing Address - Phone:815-524-1690
Mailing Address - Fax:
Practice Address - Street 1:5420 OLD ORCHARD RD STE 1A
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1053
Practice Address - Country:US
Practice Address - Phone:847-220-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.011085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical