Provider Demographics
NPI:1578902912
Name:HASSERT, DERRICK LAWRENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:LAWRENCE
Last Name:HASSERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:PROF
Other - First Name:DERRICK
Other - Middle Name:L
Other - Last Name:HASSERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:6601 WEST COLLEGE DRIVE
Mailing Address - Street 2:VANDER VELDE HALL
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-239-4862
Mailing Address - Fax:
Practice Address - Street 1:3624 216TH ST
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2713
Practice Address - Country:US
Practice Address - Phone:815-274-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003117A101YM0800X
IL180.010878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health