Provider Demographics
NPI:1508132598
Name:SIEGEL, ROB
Entity Type:Individual
Prefix:DR
First Name:ROB
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W CHICAGO AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3355
Mailing Address - Country:US
Mailing Address - Phone:312-401-0068
Mailing Address - Fax:
Practice Address - Street 1:211 W CHICAGO AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3355
Practice Address - Country:US
Practice Address - Phone:312-401-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-24
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical