Provider Demographics
NPI:1922563022
Name:WAHIDI, HIRA (DT)
Entity Type:Individual
Prefix:
First Name:HIRA
Middle Name:
Last Name:WAHIDI
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4934 MULFORD ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3159
Mailing Address - Country:US
Mailing Address - Phone:224-392-0612
Mailing Address - Fax:
Practice Address - Street 1:4934 MULFORD ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3159
Practice Address - Country:US
Practice Address - Phone:224-392-0612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist