Provider Demographics
NPI:1376732255
Name:HARDIE, JOHN CHRISTIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTIAN
Last Name:HARDIE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N SHERIDAN RD
Mailing Address - Street 2:APT. 9E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4954
Mailing Address - Country:US
Mailing Address - Phone:312-810-5646
Mailing Address - Fax:773-913-2395
Practice Address - Street 1:85 REVERE DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:847-559-9343
Practice Address - Fax:773-913-2395
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007352103TH0004X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid
ILIL7705Medicare UPIN