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General NPI Number Information
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NPI Number | 1700197480
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Entity Type | Organization
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Legal Business Name | GLENDALE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 06/28/2010
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 125 FAIRFIELD WAY STE 280
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1577
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Country | US
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Telephone | 630-440-5406
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Fax | 630-812-0443
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Provider Business Mailing Address
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Address Line | 125 FAIRFIELD WAY STE 280
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1577
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Country | US
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Telephone | 630-440-5406
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Fax | 630-812-0443
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Authorized Official
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Title or Position | PRES.
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Name | DR. CRAIG WARREN HJORTH
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Credential | PHD
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Telephone | 630-440-5406
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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 | 071003308
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License Number State | IL
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