Provider Demographics
NPI:1336125400
Name:MICETIC, AIMEE (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:AIMEE
Middle Name:
Last Name:MICETIC
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 HAWTHORNE RDG
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-4101
Mailing Address - Country:US
Mailing Address - Phone:815-274-3416
Mailing Address - Fax:
Practice Address - Street 1:13300 DIVISION ST
Practice Address - Street 2:SUITE C4
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-9847
Practice Address - Country:US
Practice Address - Phone:815-274-3416
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional