Provider Demographics
NPI:1114299443
Name:WILLIS, KANDEE LAYNE (LPC)
Entity Type:Individual
Prefix:
First Name:KANDEE
Middle Name:LAYNE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1401
Mailing Address - Country:US
Mailing Address - Phone:630-966-4336
Mailing Address - Fax:630-859-2994
Practice Address - Street 1:1230 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1401
Practice Address - Country:US
Practice Address - Phone:630-966-4336
Practice Address - Fax:630-859-2994
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.004162101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor