Provider Demographics
NPI:1356697239
Name:ANTANAVICIENE, SAULENA (MS)
Entity type:Individual
Prefix:MRS
First Name:SAULENA
Middle Name:
Last Name:ANTANAVICIENE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12727 S 82ND CT
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-2018
Mailing Address - Country:US
Mailing Address - Phone:708-590-9533
Mailing Address - Fax:708-590-0819
Practice Address - Street 1:12727 S 82ND CT
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-2018
Practice Address - Country:US
Practice Address - Phone:708-590-9533
Practice Address - Fax:708-590-0819
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional