Provider Demographics
NPI:1134507528
Name:VEENEMAN, MARY ANN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:VEENEMAN
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 1:3231 CUMBERLAND TRL
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1142
Mailing Address - Country:US
Mailing Address - Phone:708-446-4006
Mailing Address - Fax:
Practice Address - Street 1:18154 HARWOOD
Practice Address - Street 2:SUITE 102
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2102
Practice Address - Country:US
Practice Address - Phone:708-446-4006
Practice Address - Fax:708-647-8337
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001985101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor