Provider Demographics
NPI:1326502246
Name:VERMAAT, JACQUELINE CLARE (MS, LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CLARE
Last Name:VERMAAT
Suffix:
Gender:F
Credentials:MS, LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BEECH ST STE 12A
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1499
Mailing Address - Country:US
Mailing Address - Phone:309-247-1738
Mailing Address - Fax:
Practice Address - Street 1:1100 BEECH ST
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1493
Practice Address - Country:US
Practice Address - Phone:309-247-1738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014449101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional