Provider Demographics
NPI:1912095043
Name:WEGNER, ELIZABETH LYNN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LYNN
Last Name:WEGNER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2752 N HAMPDEN CT
Mailing Address - Street 2:APT #4NN
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4839
Mailing Address - Country:US
Mailing Address - Phone:773-868-6349
Mailing Address - Fax:847-328-1295
Practice Address - Street 1:820 DAVIS ST
Practice Address - Street 2:SUITE 450
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4431
Practice Address - Country:US
Practice Address - Phone:847-425-7413
Practice Address - Fax:847-328-1295
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional