MEDICARE: MRS. VICTORIA R LAVICK-SCUDDER LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	180.007740	IL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	25060	IL
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	27266	IL
4	101YP2500X	Professional Counselor	180007740	IL

General Provider Information

NPI Number	:	1225498389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA R LAVICK-SCUDDER LCPC

Provider Business Mailing Address
First Line	:	8801 W. PFEIFFER RD
Second Line	:
City	:	MAPLETON
State	:	IL
Zip	:	61547
Country	:	US
Telephone Number	:	309-550-9903
Fax Number	:	800-554-2401

Provider Business Practice Location Address
First Line	:	8801 W. PFEIFFER RD
Second Line	:
City	:	MAPLETON
State	:	IL
Zip	:	61547
Country	:	US
Telephone Number	:	309-550-9903
Fax Number	:	800-554-2401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	06/26/2024

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