Healthcare Provider Details

I. General information

NPI: 1649593757
Provider Name (Legal Business Name): FAYE ANN HOAG M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LAKE COOK RD SUITE 221
DEERFIELD IL
60015-5607
US

IV. Provider business mailing address

646 PINE LN
WINNETKA IL
60093-2029
US

V. Phone/Fax

Practice location:
  • Phone: 847-446-0951
  • Fax:
Mailing address:
  • Phone: 847-446-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149013313
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: