Provider Demographics
NPI:1871002097
Name:HUBERT, HILLARY ROSE (EDS)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:ROSE
Last Name:HUBERT
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13657 E 10500N RD
Mailing Address - Street 2:
Mailing Address - City:GRANT PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60940-5021
Mailing Address - Country:US
Mailing Address - Phone:815-370-4961
Mailing Address - Fax:
Practice Address - Street 1:13657 E 10500N RD
Practice Address - Street 2:
Practice Address - City:GRANT PARK
Practice Address - State:IL
Practice Address - Zip Code:60940-5021
Practice Address - Country:US
Practice Address - Phone:815-370-4961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2383551103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool