Healthcare Provider Details

I. General information

NPI: 1619082179
Provider Name (Legal Business Name): ALAN T. HIRSCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W NORTH AVE
WEST CHICAGO IL
60185-6224
US

IV. Provider business mailing address

3023 BENNETT DR
NAPERVILLE IL
60564-5176
US

V. Phone/Fax

Practice location:
  • Phone: 630-674-6791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.004215
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: