Provider Demographics
NPI:1306547120
Name:RANDA, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:RANDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S 4TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4162
Mailing Address - Country:US
Mailing Address - Phone:217-347-5880
Mailing Address - Fax:
Practice Address - Street 1:1901 S 4TH ST STE 212
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4162
Practice Address - Country:US
Practice Address - Phone:217-347-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health