Provider Demographics
NPI:1063853307
Name:BATHJE, GEOFFREY J (PHD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:J
Last Name:BATHJE
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 1:940 HOLBROOK RD APT 30A
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-4529
Mailing Address - Country:US
Mailing Address - Phone:312-291-1978
Mailing Address - Fax:
Practice Address - Street 1:3324 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4935
Practice Address - Country:US
Practice Address - Phone:312-291-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL003125963103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical