Provider Demographics
NPI:1205541968
Name:DEAN, VANESSA ELIZABETH (PH D, QMHP, CADC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ELIZABETH
Last Name:DEAN
Suffix:
Gender:F
Credentials:PH D, QMHP, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 S KOSTNER AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1126
Mailing Address - Country:US
Mailing Address - Phone:773-412-0410
Mailing Address - Fax:
Practice Address - Street 1:7601 S KOSTNER AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1126
Practice Address - Country:US
Practice Address - Phone:773-412-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33548101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty