Provider Information for 1689089377
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WANDA PARKER MA, CADC, LCPC
Sex: Female
NPI: 1689089377
Last Updated: 2023-03-14
Certification Date: 2023-03-14
Certification Date: 2023-03-14
Details
Name | Value | ||||||||||||||||
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NPI | 1689089377 | ||||||||||||||||
Enumeration Date | 2014-06-22 | ||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||
Sole Proprietor | YES | ||||||||||||||||
Status | Active | ||||||||||||||||
Mailing Address | 14710 CENTRAL AVE APARTMENT C319 OAK FOREST, IL 60452-1252 United States Phone: 773-575-9631 | Fax: | ||||||||||||||||
Primary Practice Address | 14710 CENTRAL AVE APARTMENT C319 OAK FOREST, IL 60452-1252 United States Phone: 773-575-9631 | Fax: | ||||||||||||||||
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