Provider Demographics
NPI:1114073509
Name:WALDNER, MARLENE ANNE (LCPC MS)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:ANNE
Last Name:WALDNER
Suffix:
Gender:F
Credentials:LCPC MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 65TH STREET
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3021
Mailing Address - Country:US
Mailing Address - Phone:630-852-8873
Mailing Address - Fax:630-852-8873
Practice Address - Street 1:601 65TH STREET
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3021
Practice Address - Country:US
Practice Address - Phone:630-852-8873
Practice Address - Fax:630-852-8873
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1262101YA0400X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional