Provider Demographics
NPI:1790596799
Name:HARDY, MYIESHA
Entity type:Individual
Prefix:
First Name:MYIESHA
Middle Name:
Last Name:HARDY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15432 PARK LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1365
Mailing Address - Country:US
Mailing Address - Phone:708-537-0094
Mailing Address - Fax:
Practice Address - Street 1:15432 PARK LN
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1365
Practice Address - Country:US
Practice Address - Phone:708-537-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child