Provider Demographics
NPI:1710421334
Name:HENDRICKSON, MOLLY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:MEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 E CHICAGO AVE
Mailing Address - Street 2:1050
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2637
Mailing Address - Country:US
Mailing Address - Phone:847-686-0090
Mailing Address - Fax:847-686-0090
Practice Address - Street 1:211 E CHICAGO AVE
Practice Address - Street 2:1050
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2637
Practice Address - Country:US
Practice Address - Phone:847-686-0090
Practice Address - Fax:847-686-0090
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist