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General NPI Number Information
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NPI Number | 1730670944
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Entity Type | Individual
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Provider Name | HEATHER LYN HUG LMT, CMLDT
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Gender | Female
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 205 W RANDOLPH ST STE 1800
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City | CHICAGO
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State | IL
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Zip | 60606-1820
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Country | US
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Telephone | 312-757-1882
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Fax |
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Provider Business Mailing Address
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Address Line | 257 E QUINCY ST
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City | RIVERSIDE
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State | IL
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Zip | 60546-2174
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Country | US
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Telephone | 708-691-2570
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227.013642
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License Number State | IL
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