Organization
JOHN HARDIE PHD CLINICAL PSYCHOLOGIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YESENIA SERVIN CPMSM, PESC (CREDENTIALING MANANGER)
(708) 979-9082
Entity
Organization
Contact information
Practice address
85 REVERE DR STE G, NORTHBROOK, IL 60062-8001
(847) 559-9343
(773) 913-2395
Mailing address
85 REVERE DR STE G, NORTHBROOK, IL 60062-8001
(847) 559-9343
(773) 913-2395
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
103TH0100X
Health Service Psychologist
—
—
Other
Enumeration date
07/06/2021
Last updated
07/06/2021
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