Provider Demographics
NPI:1700197480
Name:GLENDALE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:GLENDALE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:HJORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-440-5406
Mailing Address - Street 1:125 FAIRFIELD WAY STE 280
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1577
Mailing Address - Country:US
Mailing Address - Phone:630-440-5406
Mailing Address - Fax:630-812-0443
Practice Address - Street 1:125 FAIRFIELD WAY STE 280
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1577
Practice Address - Country:US
Practice Address - Phone:630-440-5406
Practice Address - Fax:630-812-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty