Provider Demographics
NPI:1124204037
Name:HJERTQUIST, ROBERT SCOTT (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SCOTT
Last Name:HJERTQUIST
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5058 W 89TH PL
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1636
Mailing Address - Country:US
Mailing Address - Phone:708-704-0376
Mailing Address - Fax:
Practice Address - Street 1:8941 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-6132
Practice Address - Country:US
Practice Address - Phone:708-704-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist