Provider Demographics
NPI:1861549982
Name:HLETKO, ELIZABETH WERDEN (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:WERDEN
Last Name:HLETKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2624
Mailing Address - Country:US
Mailing Address - Phone:312-371-3661
Mailing Address - Fax:
Practice Address - Street 1:501 W OGDEN AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3179
Practice Address - Country:US
Practice Address - Phone:630-920-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent