Basic Information
| Provider Information | |||||||||
| NPI: | 1811410459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHATIA | ||||||||
| FirstName: | VICKIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 S 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | HINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601413030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435775011 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5000 S 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | HINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435775011 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2017 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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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 | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103TC0700X | 071010104 | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.