Provider Demographics
NPI:1184169518
Name:SESTERHENN, CARRIE (LAC)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:SESTERHENN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2444 W LELAND AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2939
Mailing Address - Country:US
Mailing Address - Phone:773-443-5856
Mailing Address - Fax:
Practice Address - Street 1:2444 W LELAND AVE
Practice Address - Street 2:APT. 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2939
Practice Address - Country:US
Practice Address - Phone:773-443-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001350171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist