Provider Demographics
NPI:1679706006
Name:WELLS, CATHERINE MARY CHRIETZBERG (LCPC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARY CHRIETZBERG
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:MARY
Other - Last Name:CHRIETZBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8550 CASCADE ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62563-7959
Mailing Address - Country:US
Mailing Address - Phone:217-561-1159
Mailing Address - Fax:
Practice Address - Street 1:8550 CASCADE ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62563-7959
Practice Address - Country:US
Practice Address - Phone:217-561-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006262101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor