Provider Demographics
NPI:1891826582
Name:ANDERSON, DIANN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:DIANN
Middle Name:
Last Name:ANDERSON
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 1:1308 CALVIN CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7708
Mailing Address - Country:US
Mailing Address - Phone:630-420-1588
Mailing Address - Fax:630-420-0319
Practice Address - Street 1:445 W JACKSON AVE STE 206
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5258
Practice Address - Country:US
Practice Address - Phone:630-420-2596
Practice Address - Fax:630-420-2796
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional