Healthcare Provider Details

I. General information

NPI: 1144693961
Provider Name (Legal Business Name): HERITAGE PROFESSIONAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E CHESTNUT ST RCCW THIRD FLOOR
CHICAGO IL
60611-2014
US

IV. Provider business mailing address

120 E OGDEN AVE SUITE 220
HINSDALE IL
60521-3542
US

V. Phone/Fax

Practice location:
  • Phone: 312-787-8425
  • Fax:
Mailing address:
  • Phone: 630-325-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. TRACI PAVLIK
Title or Position: OFFICE MANAGER
Credential:
Phone: 630-325-5300