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Individual

SETH R. HATLELID

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSY.D.

Contact information

Practice address
1015 S MERCER AVE, BLOOMINGTON, IL 61701-7107
(309) 706-9532
(309) 588-4115
Mailing address
PO BOX 604, BLOOMINGTON, IL 61702-0604
(309) 706-3190
(309) 588-4115

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.006972
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
05732028
BLUE CROSS BLUE SHIELD
Enumeration date
07/21/2006
Last updated
06/11/2010
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