Provider Demographics
NPI:1023443298
Name:WASH, HATTIE MAE (PSYD)
Entity type:Individual
Prefix:DR
First Name:HATTIE
Middle Name:MAE
Last Name:WASH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E 79TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-2302
Mailing Address - Country:US
Mailing Address - Phone:773-224-7386
Mailing Address - Fax:
Practice Address - Street 1:7601 S KOSTNER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1126
Practice Address - Country:US
Practice Address - Phone:773-224-7386
Practice Address - Fax:773-224-7386
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181.001.1258101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health