Healthcare Provider Details

I. General information

NPI: 1083916688
Provider Name (Legal Business Name): JOANNE E HATTENDORF ED D LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N HAMMES AVE SUITE 3
JOLIET IL
60435-6677
US

IV. Provider business mailing address

200 N HAMMES AVE SUITE 3
JOLIET IL
60435-6677
US

V. Phone/Fax

Practice location:
  • Phone: 815-744-8253
  • Fax:
Mailing address:
  • Phone: 815-744-8253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number071005887
License Number StateIL

VIII. Authorized Official

Name: JOANNE E HATTENDORF
Title or Position: PRESIDENT
Credential: EDD
Phone: 815-744-8253