Provider Demographics
NPI:1497516348
Name:KAUFFMAN, CHARLOTTE DIANE
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:DIANE
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7716 HUNT RD.
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62712
Mailing Address - Country:US
Mailing Address - Phone:217-220-6329
Mailing Address - Fax:
Practice Address - Street 1:7716 HUNT RD.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62712
Practice Address - Country:US
Practice Address - Phone:217-220-6329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004344101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health