Provider Demographics
NPI:1104955459
Name:ROBERT HJERTQUIST, INC.
Entity type:Organization
Organization Name:ROBERT HJERTQUIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HJERTQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:708-704-0376
Mailing Address - Street 1:5058 W 89TH PL
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1636
Mailing Address - Country:US
Mailing Address - Phone:708-704-0376
Mailing Address - Fax:
Practice Address - Street 1:8941 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-6132
Practice Address - Country:US
Practice Address - Phone:708-704-0376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001633981Medicare UPIN