Provider Demographics
NPI:1689390296
Name:HAYES, RUDY (MA)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:
Last Name:HAYES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S RIVERSIDE PLZ STE 875
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3717
Mailing Address - Country:US
Mailing Address - Phone:312-474-6189
Mailing Address - Fax:
Practice Address - Street 1:10 S RIVERSIDE PLZ STE 875
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3717
Practice Address - Country:US
Practice Address - Phone:312-474-6189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL17014Medicaid