Provider Demographics
NPI:1740832914
Name:INMAN, NATALIE RAE (BA, CADC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:RAE
Last Name:INMAN
Suffix:
Gender:F
Credentials:BA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W SPRESSER ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-1849
Mailing Address - Country:US
Mailing Address - Phone:217-777-3841
Mailing Address - Fax:217-777-3843
Practice Address - Street 1:508 W SPRESSER ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1849
Practice Address - Country:US
Practice Address - Phone:217-777-3841
Practice Address - Fax:217-777-3843
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL35094101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)