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General NPI Number Information
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NPI Number | 1699142091
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Entity Type | Individual
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Provider Name | JASON HACKER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE STE 2015
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City | CHICAGO
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State | IL
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Zip | 60602-3611
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Country | US
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Telephone | 312-925-6330
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N MICHIGAN AVE STE 2015
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City | CHICAGO
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State | IL
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Zip | 60602-3611
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Country | US
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Telephone | 312-925-6330
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY1001016
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071009274
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License Number State | IL
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