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NPI Code Detail

MEDICARE: HEATHER TREAT LP

MEDICARE: HEATHER TREAT LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist71.009250IL

General Provider Information

NPI Number : 1316396096
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER TREAT LP
Provider Business Mailing Address
First Line : 1448 N MILWAUKEE AVE STE 205
Second Line :
City : CHICAGO
State : IL
Zip : 60622-9225
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1754 N WASHINGTON ST STE 120
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-1462
Country : US
Telephone Number : 312-476-9064
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2016
Last Update Date : 06/03/2016

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