Healthcare Provider Details

I. General information

NPI: 1952816894
Provider Name (Legal Business Name): PAMELA JEAN HOCHREITER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WILLOW ST
FRANKFORT IL
60423-1140
US

IV. Provider business mailing address

6011 JAMES ST
TINLEY PARK IL
60477-1974
US

V. Phone/Fax

Practice location:
  • Phone: 815-806-4600
  • Fax:
Mailing address:
  • Phone: 708-532-5603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1900931
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: