Provider Demographics
NPI:1215250444
Name:HESSE, ASTRID (PSYD)
Entity type:Individual
Prefix:MS
First Name:ASTRID
Middle Name:
Last Name:HESSE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 ROGER WILLIAMS AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4820
Mailing Address - Country:US
Mailing Address - Phone:773-968-3117
Mailing Address - Fax:
Practice Address - Street 1:580 ROGER WILLIAMS AVE STE 21
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4820
Practice Address - Country:US
Practice Address - Phone:847-980-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008114103TC0700X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health