Provider Demographics
NPI:1366681397
Name:PLATH, LOUISETTE C (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUISETTE
Middle Name:C
Last Name:PLATH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:IL
Mailing Address - Zip Code:62924-3445
Mailing Address - Country:US
Mailing Address - Phone:618-549-2197
Mailing Address - Fax:
Practice Address - Street 1:151 VAUGHN RD
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:IL
Practice Address - Zip Code:62924-3445
Practice Address - Country:US
Practice Address - Phone:618-549-2197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-15
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007333103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical