Provider Demographics
NPI:1255344628
Name:HARTKE, ROBERT JAMES (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:HARTKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 REBA PL
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2618
Mailing Address - Country:US
Mailing Address - Phone:847-866-7249
Mailing Address - Fax:
Practice Address - Street 1:636 CHURCH ST
Practice Address - Street 2:STE 617
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4586
Practice Address - Country:US
Practice Address - Phone:847-866-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-003024103TR0400X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1673046OtherBLUE CROSS/BLUE SHIELD
IL1673046OtherBLUE CROSS/BLUE SHIELD