Provider Demographics
NPI:1710225487
Name:NORTHEAST DUPAGE FAMILY AND YOUTH SERVICES
Entity type:Organization
Organization Name:NORTHEAST DUPAGE FAMILY AND YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-903-6220
Mailing Address - Street 1:777 W ARMY TRAIL BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3163
Mailing Address - Country:US
Mailing Address - Phone:630-903-6220
Mailing Address - Fax:
Practice Address - Street 1:777 W ARMY TRAIL BLVD FL 2
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3163
Practice Address - Country:US
Practice Address - Phone:630-693-7934
Practice Address - Fax:630-332-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 1041C0700X, 106H00000X, 251S00000X
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty