Provider Demographics
NPI:1639597446
Name:HUENECKE, TODD (PHD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:HUENECKE
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 1:2135 COLONIAL ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-4611
Mailing Address - Country:US
Mailing Address - Phone:630-253-5821
Mailing Address - Fax:
Practice Address - Street 1:2135 COLONIAL ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60503-4611
Practice Address - Country:US
Practice Address - Phone:630-253-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008798103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical