Provider Demographics
NPI:1316195654
Name:SANTOS, VICKI ARNOLD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:ARNOLD
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:VICKI
Other - Middle Name:ANNE
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1771 NASHVILLE LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-2916
Mailing Address - Country:US
Mailing Address - Phone:815-444-0335
Mailing Address - Fax:
Practice Address - Street 1:610 N. ROUTE 31
Practice Address - Street 2:SUITE E
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012
Practice Address - Country:US
Practice Address - Phone:815-444-8469
Practice Address - Fax:815-479-1709
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006092103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical