Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 071-003024 | IL |
N | 103TR0400X | Rehabilitation Psychologist | 071-003024 | IL |
NPI | 1255344628 |
---|---|
Provider Name | Robert James Hartke |
First Address | Evanston, IL 60202-2618 |
Second Address | Evanston, IL 60201-4586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 07/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1673046 | BLUE CROSS/BLUE SHIELD (01) | IL |