Healthcare Provider Details

I. General information

NPI: 1023822681
Provider Name (Legal Business Name): HANNAH FIDLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N OAK PARK AVE STE 400
OAK PARK IL
60301-1344
US

IV. Provider business mailing address

818 N DRAKE AVE
CHICAGO IL
60651-4048
US

V. Phone/Fax

Practice location:
  • Phone: 708-368-8800
  • Fax:
Mailing address:
  • Phone: 812-219-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.020360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: