Provider Demographics
NPI:1508949215
Name:SEDLACEK, GERALDINE L (LCPC LICENSED CLINIC)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:L
Last Name:SEDLACEK
Suffix:
Gender:F
Credentials:LCPC LICENSED CLINIC
Other - Prefix:MS
Other - First Name:JERI
Other - Middle Name:L
Other - Last Name:SEDLACEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:5300 WALNUT AVE
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-968-0736
Mailing Address - Fax:
Practice Address - Street 1:6912 MAIN ST
Practice Address - Street 2:SUITE 12
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516
Practice Address - Country:US
Practice Address - Phone:630-968-0736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
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