Healthcare Provider Details

I. General information

NPI: 1144992504
Provider Name (Legal Business Name): ALEX HILL III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 W WASHINGTON BLVD
CHICAGO IL
60612-2055
US

IV. Provider business mailing address

2651 W WASHINGTON BLVD
CHICAGO IL
60612-2055
US

V. Phone/Fax

Practice location:
  • Phone: 773-553-6809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1139225
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: