Provider Demographics
NPI:1891897344
Name:ANDERSON, PATRICIA JEAN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JEAN
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 1:205 W MINER ST
Mailing Address - Street 2:UNIT 104
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1377
Mailing Address - Country:US
Mailing Address - Phone:847-670-2932
Mailing Address - Fax:
Practice Address - Street 1:1580 N NORTHWEST HWY
Practice Address - Street 2:SUITE 10A
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1444
Practice Address - Country:US
Practice Address - Phone:847-323-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional