Ellecom, Richenel Samuel

Ellecom, Richenel Samuel is an sole proprietor health care provider with primary practice located at 621 Plainfield Rd Suite 110, Willow Brook IL 60527-5343. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Neuropsychologist, Dietary & Nutritional Service Providers / Dietitian, Registered. Dietary & Nutritional Service Providers / Dietitian, Registered is his primary health care specialty. Ellecom, Richenel Samuel can be contacted via phone (630) 654-1377.

Contact Information

Primary practice address
621 Plainfield Rd Suite 110 Willow Brook IL 60527-5343
Phone: (630) 654-1377
Fax: (630) 654-2575
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 71-5240 Illinois
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 20040961A Indiana
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X 164-2611 Illinois

Profile Details

NPI number 1063406569
LBN Legal business name Ellecom, Richenel Samuel
Credentials PSY.D; DR.P.H
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 12th, 2005
Last updated Oct 27th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063406569 NPPES
Indiana MEDICAID 200909210A
Indiana MEDICAID 200078600

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