Healthcare Provider Details

I. General information

NPI: 1174991616
Provider Name (Legal Business Name): HERITAGE PROFESSIONAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GALE AVE 2E
RIVER FOREST IL
60305-2065
US

IV. Provider business mailing address

1 GALE AVE 2E
RIVER FOREST IL
60305-2065
US

V. Phone/Fax

Practice location:
  • Phone: 708-296-9023
  • Fax:
Mailing address:
  • Phone: 708-296-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number178.010925
License Number StateIL

VIII. Authorized Official

Name: DR. THOMAS L SCHEMPER
Title or Position: DIRECTOR
Credential: PHD
Phone: 312-787-8425