Provider Demographics
NPI:1437233970
Name:REAM, VANESSA B (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:B
Last Name:REAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 N CONCORD LN
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-7799
Mailing Address - Country:US
Mailing Address - Phone:217-377-1089
Mailing Address - Fax:217-337-1267
Practice Address - Street 1:1902 N CONCORD LN
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-7799
Practice Address - Country:US
Practice Address - Phone:217-377-1089
Practice Address - Fax:217-337-1267
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490073561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001021975OtherBCBS
202508OtherPERSONAL CARE