Provider Demographics
NPI:1629656483
Name:HEITZ, HANNAH GARDINER (LPC)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:GARDINER
Last Name:HEITZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N MARSHFIELD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1390
Mailing Address - Country:US
Mailing Address - Phone:937-901-0500
Mailing Address - Fax:
Practice Address - Street 1:810 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1515
Practice Address - Country:US
Practice Address - Phone:708-848-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178015677101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional