Provider Demographics
NPI:1851608392
Name:SAMARDZIJA, HEATHER (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SAMARDZIJA
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 WILD DUNES CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-5639
Mailing Address - Country:US
Mailing Address - Phone:815-600-4678
Mailing Address - Fax:
Practice Address - Street 1:24012 W RENWICK RD STE 204A
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-8733
Practice Address - Country:US
Practice Address - Phone:815-676-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007485101YP2500X
IL180.010026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional