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General NPI Number Information
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NPI Number | 1104955459
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Entity Type | Organization
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Legal Business Name | ROBERT HJERTQUIST, INC.
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8941 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60620-6132
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Country | US
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Telephone | 708-704-0376
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Fax |
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Provider Business Mailing Address
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Address Line | 5058 W 89TH PL
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City | CROWN POINT
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State | IN
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Zip | 46307-1636
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Country | US
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Telephone | 708-704-0376
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT SCOTT HJERTQUIST
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Credential | LMFT
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Telephone | 708-704-0376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | IL
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