Provider Demographics
NPI:1689942831
Name:WOLTER, DEANNE MARIE (LCPC)
Entity Type:Individual
Prefix:DR
First Name:DEANNE
Middle Name:MARIE
Last Name:WOLTER
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 1:2155 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5943
Mailing Address - Country:US
Mailing Address - Phone:815-909-6586
Mailing Address - Fax:
Practice Address - Street 1:2155 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-5943
Practice Address - Country:US
Practice Address - Phone:815-909-6586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006643101YP2500X
IL180009211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional