Provider Demographics
NPI:1497522445
Name:HEDENSTROM, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:HEDENSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 N DAMEN AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1458
Mailing Address - Country:US
Mailing Address - Phone:312-914-6601
Mailing Address - Fax:
Practice Address - Street 1:1700 W IRVING PARK RD STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2462
Practice Address - Country:US
Practice Address - Phone:312-560-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178019668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health