Healthcare Provider Details

I. General information

NPI: 1154461366
Provider Name (Legal Business Name): DEBORAH DIANE HEGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CENTRAL AVE
HIGHLAND PARK IL
60035-3240
US

IV. Provider business mailing address

630 DOWNING RD
LIBERTYVILLE IL
60048-3709
US

V. Phone/Fax

Practice location:
  • Phone: 847-432-4981
  • Fax: 847-432-7331
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: