Provider Demographics
NPI:1326538596
Name:HARDY PERKINS, WANDA (LCSW)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:HARDY PERKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1054 W 59TH CT
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7608
Mailing Address - Country:US
Mailing Address - Phone:404-483-1323
Mailing Address - Fax:
Practice Address - Street 1:203 W MONDAMIN ST
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447
Practice Address - Country:US
Practice Address - Phone:815-333-4032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490146831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical