Provider Demographics
NPI:1689788739
Name:HAREJ, HEATHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:HAREJ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 ILLINOIS AVE
Mailing Address - Street 2:STE 2C
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2963
Mailing Address - Country:US
Mailing Address - Phone:630-377-3535
Mailing Address - Fax:630-530-9527
Practice Address - Street 1:405 ILLINOIS AVE
Practice Address - Street 2:STE 2C
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2963
Practice Address - Country:US
Practice Address - Phone:630-377-3535
Practice Address - Fax:630-530-9527
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0032240596; 00445400OtherBC/BS PROVIDER NUMBER