Provider Demographics
NPI:1467542829
Name:VANOVER, CECELIA MARY (LCPC)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:MARY
Last Name:VANOVER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60431-9782
Mailing Address - Country:US
Mailing Address - Phone:815-741-1487
Mailing Address - Fax:815-741-1487
Practice Address - Street 1:410 SHADY LN
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60431-9782
Practice Address - Country:US
Practice Address - Phone:815-741-1487
Practice Address - Fax:815-741-1487
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9926911OtherBCBS PROVIDER ID