Hazelden Chicago

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

A-9403-0001-P Issued in IL

Legal business name

HAZELDEN CHICAGO

Practice address

867 N Dearborn St
Chicago, IL 60610-3310

Phone

(800) 257-7800

Fax

(312) 943-3530

NPI assigned

Jan 2, 2007

Last updated

May 16, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ashley Gibson

Title

VP Payer Relations

Phone

(651) 213-4519

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amanda D Grove, LCSW

  • Clinical Social Worker
  • Naperville, IL
  • NPI 1669960761
  NPD (past)
• Katie Odette Washington Cole, MD-PHD

  • Addiction Psychiatry Physician
  • Chicago, IL
  • NPI 1912352469
  NPD (past)
• Alta J. Deroo, MD

  • Addiction Medicine (Preventive Medicine) Physician
  • Kalamazoo, MI
  • NPI 1184791725
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1245397959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "867 N DEARBORN ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606103310",
            "telephone_number": "800-257-7810",
            "fax_number": "312-943-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "867 N DEARBORN ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606103310",
            "telephone_number": "800-257-7800",
            "fax_number": "312-943-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZELDEN CHICAGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "VP PAYER RELATIONS",
        "authorized_official_telephone_number": "651-213-4519"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "IL",
            "license": "A-9403-0001-P",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trent T Haywood, MD, JD
• Hani Hazani, M.D.
• Maryam Helen Hazeghazam, M.D, PHD
• Jessica Jean Hazel, D.C.
• Hazelden Betty Ford Foundation
• Clive Garrad Hazell, PHD, DN
• Victoria-Rose Hazell, MA, LPC
• Devona Nicole Hazelwood, LPC
• Farrah Hazheer, CNM
• Muhammad Haziq, PHARMD

• Substance Use Disorder Rehabilitation Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.