Provider Demographics
NPI:1508227281
Name:VANICK, DARA
Entity Type:Individual
Prefix:MRS
First Name:DARA
Middle Name:
Last Name:VANICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DARA
Other - Middle Name:GAYLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19419 RT. 173 EAST
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033
Mailing Address - Country:US
Mailing Address - Phone:815-759-7055
Mailing Address - Fax:
Practice Address - Street 1:4001 W DAYTON ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8377
Practice Address - Country:US
Practice Address - Phone:815-759-7055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker