Provider Demographics
NPI:1225103401
Name:HANSON, DAVID ROBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:HANSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NORTH SHORE DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2225
Mailing Address - Country:US
Mailing Address - Phone:847-295-6141
Mailing Address - Fax:888-765-7036
Practice Address - Street 1:900 NORTH SHORE DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2225
Practice Address - Country:US
Practice Address - Phone:847-295-6141
Practice Address - Fax:888-765-7036
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006160103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4932087OtherBCBC