Provider Demographics
NPI:1275767543
Name:BOETTCHER, DANIELLE (LCPC, PHD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BOETTCHER
Suffix:
Gender:F
Credentials:LCPC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41081 N JULIA CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-2201
Mailing Address - Country:US
Mailing Address - Phone:847-514-8457
Mailing Address - Fax:
Practice Address - Street 1:41081 N JULIA CT
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-2201
Practice Address - Country:US
Practice Address - Phone:847-514-8457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional