Provider Demographics
NPI:1417005745
Name:VAISVILAS-TAYLOR, CONNIE L (LCPC, CEAP,SAP,CADC)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:L
Last Name:VAISVILAS-TAYLOR
Suffix:
Gender:F
Credentials:LCPC, CEAP,SAP,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 W JEFFERSON ST
Mailing Address - Street 2:SUITE 219
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5261
Mailing Address - Country:US
Mailing Address - Phone:815-741-2300
Mailing Address - Fax:815-741-8003
Practice Address - Street 1:3033 W JEFFERSON ST
Practice Address - Street 2:SUITE 219
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5261
Practice Address - Country:US
Practice Address - Phone:815-741-2300
Practice Address - Fax:815-741-8003
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
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