1184738031 NPI number — DR. KYLE VICTOR HUNNEKE PSY.D.

Table of content: DR. KYLE VICTOR HUNNEKE PSY.D. (NPI 1184738031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184738031 NPI number — DR. KYLE VICTOR HUNNEKE PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNNEKE
Provider First Name:
KYLE
Provider Middle Name:
VICTOR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184738031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1516 W SCHOOL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60657-2122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-498-7718
Provider Business Mailing Address Fax Number:
773-281-0852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
636 CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE 710
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201-4508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-498-7718
Provider Business Practice Location Address Fax Number:
773-281-0852
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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