Provider Demographics
NPI:1326186974
Name:HOOGENBOOM, CAROL A (PSYD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:HOOGENBOOM
Suffix:
Gender:F
Credentials:PSYD
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Mailing Address - Street 1:28 E JACKSON BLVD
Mailing Address - Street 2:#10-H580
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-2263
Mailing Address - Country:US
Mailing Address - Phone:708-848-0707
Mailing Address - Fax:267-430-8942
Practice Address - Street 1:1515 N HARLEM AVE
Practice Address - Street 2:SUITE 205-6
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1250
Practice Address - Country:US
Practice Address - Phone:708-848-0707
Practice Address - Fax:267-430-8942
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical