Organization
ESTABLISHING, MANAGING AND GENERATING EFFECTIVE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HATTIE WASH PSY D (CHIEF EXECUTIVE OFFICER)
(312) 613-2846
Entity
Organization
Contact information
Practice address
110 E. 79TH STREET, CHICAGO, IL 60619-2302
(773) 224-7683
Mailing address
110 E. 79TH STREET, CHICAGO, IL 60619-2302
(773) 224-7685
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
A-5889-0001-A
IL
Other
Enumeration date
02/07/2008
Last updated
02/07/2008
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