Provider Demographics
NPI:1558385385
Name:BENDICSEN, HAROLD KRISTIAN (MSW)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:KRISTIAN
Last Name:BENDICSEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 E BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2909
Mailing Address - Country:US
Mailing Address - Phone:630-279-5216
Mailing Address - Fax:
Practice Address - Street 1:579 W NORTH AVE
Practice Address - Street 2:302
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2136
Practice Address - Country:US
Practice Address - Phone:630-279-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490003971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical