Healthcare Provider Details

I. General information

NPI: 1255344628
Provider Name (Legal Business Name): ROBERT JAMES HARTKE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 CHURCH ST STE 617
EVANSTON IL
60201-4586
US

IV. Provider business mailing address

829 REBA PL
EVANSTON IL
60202-2618
US

V. Phone/Fax

Practice location:
  • Phone: 847-866-7249
  • Fax:
Mailing address:
  • Phone: 847-866-7249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number071-003024
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number071-003024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: