Provider Demographics
NPI:1982770103
Name:BENNETT, RONALD WAYNE (LCPC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WAYNE
Last Name:BENNETT
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1053
Mailing Address - Country:US
Mailing Address - Phone:815-351-2299
Mailing Address - Fax:815-469-9202
Practice Address - Street 1:809 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1053
Practice Address - Country:US
Practice Address - Phone:815-351-2299
Practice Address - Fax:815-469-9202
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL244552OtherCOMPSYCH
IL192753OtherVALUEOPTIONS
IL09932319OtherBLUE CROSS BLUE SHIELD