Provider Demographics
NPI:1548776636
Name:ANGSTMANN, VICKI LYNN (LCPC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:ANGSTMANN
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 1:302 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAYBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:61770-9496
Mailing Address - Country:US
Mailing Address - Phone:309-475-9017
Mailing Address - Fax:
Practice Address - Street 1:4 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-2000
Practice Address - Country:US
Practice Address - Phone:217-784-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011326101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.011326OtherSTATE OF ILLINOIS LICENSE