Provider Demographics
NPI:1346532561
Name:LINDSTROM, VALERIE M (LCAC)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:M
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17949 GOTTSCHALK AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1709
Mailing Address - Country:US
Mailing Address - Phone:708-254-1404
Mailing Address - Fax:
Practice Address - Street 1:17949 GOTTSCHALK AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1709
Practice Address - Country:US
Practice Address - Phone:708-254-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000427A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)