Provider Demographics
NPI:1033244173
Name:HERITAGE PROFESSIONAL ASSOCIATES LTD
Entity Type:Organization
Organization Name:HERITAGE PROFESSIONAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD ABPP
Authorized Official - Phone:630-325-5300
Mailing Address - Street 1:120 E OGDEN AVE 220
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:630-325-5300
Mailing Address - Fax:630-325-5309
Practice Address - Street 1:120 E OGDEN AVE 220
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-325-5300
Practice Address - Fax:630-325-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060005612103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215636OtherBCBS OF IL
IL02215636OtherBCBS OF IL