=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770135741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAIGE A. HOVER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2019
-----------------------------------------------------
Last Update Date | 07/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4305 N LINCOLN AVE STE P
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60618-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-546-3608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2330 W BELMONT AVE UNIT 2
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60618-6535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-624-7044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PAIGE HOVER
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 607-624-7044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------