Provider Demographics
NPI:1679688246
Name:HOBFOLL, IVONNE HERAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:IVONNE
Middle Name:HERAS
Last Name:HOBFOLL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:IVONNE
Other - Middle Name:
Other - Last Name:HERAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1653 W CONGRESS PARKWAY
Mailing Address - Street 2:RUSH UNIVERSITY MEDICAL CENTER-DEPT. BEHAVIORAL SCIENCE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3244
Mailing Address - Country:US
Mailing Address - Phone:312-942-5932
Mailing Address - Fax:312-942-4990
Practice Address - Street 1:1653 W CONGRESS PARKWAY
Practice Address - Street 2:RUSH UNIVERSITY MEDICAL CENTER-DEPT. BEHAVIORAL SCIENCE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3244
Practice Address - Country:US
Practice Address - Phone:312-942-5932
Practice Address - Fax:312-942-4990
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003526103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R03903OtherSUMMA
4130254OtherAETNA
R03903OtherSUMMA