Provider Demographics
NPI:1124029988
Name:HSIEH, JON D (LCSW)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:D
Last Name:HSIEH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 E MAIN ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2287
Mailing Address - Country:US
Mailing Address - Phone:630-377-6613
Mailing Address - Fax:630-377-6225
Practice Address - Street 1:207 E CHURCH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-9803
Practice Address - Country:US
Practice Address - Phone:815-786-8606
Practice Address - Fax:815-786-1541
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0102741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206339Medicare PIN