Provider Demographics
NPI:1477605673
Name:DENEXTERBLOKLAND, VICKI L (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:L
Last Name:DENEXTERBLOKLAND
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 1:2615 THREE OAKS RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013
Mailing Address - Country:US
Mailing Address - Phone:708-962-0547
Mailing Address - Fax:
Practice Address - Street 1:2615 THREE OAKS RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013
Practice Address - Country:US
Practice Address - Phone:708-962-0547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
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