Provider Demographics
NPI:1760788426
Name:KRIEGER-ERICKSON, WENDY S (LCPC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:KRIEGER-ERICKSON
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 1:4160 RFD # 83
Mailing Address - Street 2:STE. 204
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-9583
Mailing Address - Country:US
Mailing Address - Phone:224-305-2759
Mailing Address - Fax:
Practice Address - Street 1:4160 RFD # 83
Practice Address - Street 2:STE. 204
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-9583
Practice Address - Country:US
Practice Address - Phone:224-305-2759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.000535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health