Provider Demographics
NPI:1144876764
Name:AUFMUTH, ELYSIA MEHARRY (LCSW)
Entity type:Individual
Prefix:
First Name:ELYSIA
Middle Name:MEHARRY
Last Name:AUFMUTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5033 N KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1147
Mailing Address - Country:US
Mailing Address - Phone:773-339-2269
Mailing Address - Fax:
Practice Address - Street 1:900 SKOKIE BLVD STE 218
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4043
Practice Address - Country:US
Practice Address - Phone:847-668-4295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-11
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149015094104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker