Provider Demographics
NPI:1073204053
Name:BUCKELEW, EMILY (MA, MS, LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BUCKELEW
Suffix:
Gender:F
Credentials:MA, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 E BUTTERFIELD RD STE 212
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4879
Mailing Address - Country:US
Mailing Address - Phone:630-866-5666
Mailing Address - Fax:
Practice Address - Street 1:477 E BUTTERFIELD RD STE 212
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4879
Practice Address - Country:US
Practice Address - Phone:630-866-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178019114101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional