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General NPI Number Information
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NPI Number | 1063853307
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Entity Type | Individual
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Provider Name | GEOFFREY J BATHJE PHD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 3324 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60647-4935
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Country | US
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Telephone | 312-291-1978
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Fax |
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Provider Business Mailing Address
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Address Line | 940 HOLBROOK RD APT 30A
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City | HOMEWOOD
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State | IL
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Zip | 60430-4529
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Country | US
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Telephone | 312-291-1978
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 003125963
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License Number State | IL
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