Provider Demographics
NPI:1972136216
Name:KOLLMER, HEATHER LOUISE (LCPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LOUISE
Last Name:KOLLMER
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 1:1429 W BARRY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4205
Mailing Address - Country:US
Mailing Address - Phone:773-294-7910
Mailing Address - Fax:
Practice Address - Street 1:444 S RAND RD STE 207
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2307
Practice Address - Country:US
Practice Address - Phone:847-942-4920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010602101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional