Provider Demographics
NPI:1386924322
Name:MIDED, ANDY HANSEN (MA)
Entity type:Individual
Prefix:MR
First Name:ANDY
Middle Name:HANSEN
Last Name:MIDED
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 BARK WOOD ROAD
Mailing Address - Street 2:#106
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-6604
Mailing Address - Country:US
Mailing Address - Phone:312-213-6367
Mailing Address - Fax:
Practice Address - Street 1:6415 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3130
Practice Address - Country:US
Practice Address - Phone:708-745-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2025-12-23
Deactivation Date:2014-07-08
Deactivation Code:
Reactivation Date:2025-12-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health