Healthcare Provider Details

I. General information

NPI: 1205791316
Provider Name (Legal Business Name): JUSTIN HADLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 22ND ST STE 158
LOMBARD IL
60148-6175
US

IV. Provider business mailing address

2019 CHURCH ST
EVANSTON IL
60201-3967
US

V. Phone/Fax

Practice location:
  • Phone: 630-491-6994
  • Fax:
Mailing address:
  • Phone: 224-639-6187
  • Fax: 224-639-6187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.115689
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: