Provider Demographics
NPI:1770820250
Name:BEHNKE, DIANE (MS CPC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BEHNKE
Suffix:
Gender:F
Credentials:MS CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3309
Mailing Address - Country:US
Mailing Address - Phone:847-784-6078
Mailing Address - Fax:847-784-6088
Practice Address - Street 1:161 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3309
Practice Address - Country:US
Practice Address - Phone:847-784-6078
Practice Address - Fax:847-784-6088
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178000247101YP2500X
IL20080040171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional