Healthcare Provider Details

I. General information

NPI: 1679688246
Provider Name (Legal Business Name): IVONNE HERAS HOBFOLL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IVONNE HERAS PHD

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PARKWAY RUSH UNIVERSITY MEDICAL CENTER-DEPT. BEHAVIORAL SCIENCE
CHICAGO IL
60612-3244
US

IV. Provider business mailing address

1653 W CONGRESS PARKWAY RUSH UNIVERSITY MEDICAL CENTER-DEPT. BEHAVIORAL SCIENCE
CHICAGO IL
60612-3244
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5932
  • Fax: 312-942-4990
Mailing address:
  • Phone: 312-942-5932
  • Fax: 312-942-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071003526
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: