Provider Demographics
NPI:1730136078
Name:PLASTARAS, HEATHER D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:D
Last Name:PLASTARAS
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 1:600 W FULTON ST
Mailing Address - Street 2:STE. 304
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1259
Mailing Address - Country:US
Mailing Address - Phone:773-580-3879
Mailing Address - Fax:
Practice Address - Street 1:600 W FULTON ST
Practice Address - Street 2:STE. 304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1259
Practice Address - Country:US
Practice Address - Phone:773-580-3879
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
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