Provider Demographics
NPI:1295922805
Name:ANDERSON, HEATHER (LCPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
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 1:373 S SCHMALE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2771
Mailing Address - Country:US
Mailing Address - Phone:630-682-1910
Mailing Address - Fax:630-682-3094
Practice Address - Street 1:122 W LIBERTY DR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5124
Practice Address - Country:US
Practice Address - Phone:630-682-1910
Practice Address - Fax:630-682-0655
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001484101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional