Provider Demographics
NPI:1578634994
Name:HANLON, ROBERT E (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:HANLON
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 1:1000 W WASHINGTON BLVD
Mailing Address - Street 2:#336
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2137
Mailing Address - Country:US
Mailing Address - Phone:312-202-0755
Mailing Address - Fax:312-202-0750
Practice Address - Street 1:645 N MICHIGAN AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2826
Practice Address - Country:US
Practice Address - Phone:312-202-0755
Practice Address - Fax:312-202-0750
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634309OtherBLUE CROSSPROVIDER NUMBER
IL209803Medicare PIN