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General NPI Number Information
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NPI Number | 1700270964
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Entity Type | Organization
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Legal Business Name | HAZELDEN BETTY FORD FOUNDATION
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 867 N DEARBORN ST
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City | CHICAGO
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State | IL
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Zip | 60610-3310
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Country | US
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Telephone | 312-943-3534
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Fax |
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Provider Business Mailing Address
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Address Line | 318 LEE ST
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City | EVANSTON
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State | IL
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Zip | 60202-1898
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CD PROFESSION 1
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Name | JENNIFER MOSELEY
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Credential | MA, CADC
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Telephone | 312-943-3534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | IL
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