Provider Demographics
NPI:1073234225
Name:SUTTON, TONI VANESSA (LCPC)
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:VANESSA
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 HUNTINGTON CT
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-9656
Mailing Address - Country:US
Mailing Address - Phone:708-299-6460
Mailing Address - Fax:
Practice Address - Street 1:500 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2328
Practice Address - Country:US
Practice Address - Phone:815-214-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional