Provider Demographics
NPI:1225116296
Name:KATH-LANTERMAN, SANDRA H (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:H
Last Name:KATH-LANTERMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:KATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:207 PRIDELAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404
Mailing Address - Country:US
Mailing Address - Phone:815-730-8900
Mailing Address - Fax:815-730-0988
Practice Address - Street 1:3033 WEST JEFFERSON STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-773-0772
Practice Address - Fax:815-773-0771
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001489101YM0800X
IL180.001489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10283OtherCADC