Provider Demographics
NPI:1023199262
Name:VATTHAUER, KAREN J (LCPC, BCPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:VATTHAUER
Suffix:
Gender:F
Credentials:LCPC, BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:800 N. WEBSTER ST.
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-0194
Mailing Address - Country:US
Mailing Address - Phone:217-827-2877
Mailing Address - Fax:217-824-3451
Practice Address - Street 1:800 N WEBSTER ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1258
Practice Address - Country:US
Practice Address - Phone:217-827-2877
Practice Address - Fax:217-824-3451
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional