Basic Information
| Provider Information | |||||||||
| NPI: | 1598205098 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BASSIJ | ||||||||
| FirstName: | AZADEH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1056 BEDFORD DR | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601883920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308859222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 ROHWING RD. | ||||||||
| Address2: | KENNETH YOUNG CENTER | ||||||||
| City: | ELK GROVE VILLAGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475248800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2017 | ||||||||
| LastUpdateDate: | 03/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.