Provider Demographics
NPI:1912211319
Name:WACHTEL, AILI (LCPC)
Entity Type:Individual
Prefix:
First Name:AILI
Middle Name:
Last Name:WACHTEL
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 1:2607 HODDAM RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5874
Mailing Address - Country:US
Mailing Address - Phone:630-335-5187
Mailing Address - Fax:
Practice Address - Street 1:2607 HODDAM RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5874
Practice Address - Country:US
Practice Address - Phone:630-335-5187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health