Healthcare Provider Details

I. General information

NPI: 1033190715
Provider Name (Legal Business Name): HINSDALE PSYCHOLOGICAL RESOURCES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CHESTNUT ST STE 206
HINSDALE IL
60521-3247
US

IV. Provider business mailing address

333 CHESTNUT ST STE 206
HINSDALE IL
60521-3247
US

V. Phone/Fax

Practice location:
  • Phone: 630-850-9650
  • Fax: 630-850-9607
Mailing address:
  • Phone: 630-850-9650
  • Fax: 630-850-9607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name: PATRICIA J. ANDRISE
Title or Position: OWNER
Credential: PH.D.
Phone: 630-850-9650