Provider Demographics
NPI:1710119326
Name:WASSON, TONI S (MS/LCPC/LPC)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:S
Last Name:WASSON
Suffix:
Gender:F
Credentials:MS/LCPC/LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14251 LAUBE RD
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:IL
Mailing Address - Zip Code:61024-9651
Mailing Address - Country:US
Mailing Address - Phone:815-973-5153
Mailing Address - Fax:
Practice Address - Street 1:14251 LAUBE RD
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:IL
Practice Address - Zip Code:61024-9651
Practice Address - Country:US
Practice Address - Phone:815-973-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002317101YM0800X
WI2748-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health