Provider Demographics
NPI:1730670944
Name:HUG, HEATHER LYN (LMT, CMLDT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYN
Last Name:HUG
Suffix:
Gender:F
Credentials:LMT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 E QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2174
Mailing Address - Country:US
Mailing Address - Phone:708-691-2570
Mailing Address - Fax:
Practice Address - Street 1:205 W RANDOLPH ST STE 1800
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1820
Practice Address - Country:US
Practice Address - Phone:312-757-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.013642225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist