Healthcare Provider Details

I. General information

NPI: 1972326825
Provider Name (Legal Business Name): LINDA KAY IMPASTATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W LAKE ST
ADDISON IL
60101-1197
US

IV. Provider business mailing address

138 SANTA FE LN
WILLOW SPRINGS IL
60480-1199
US

V. Phone/Fax

Practice location:
  • Phone: 630-682-7400
  • Fax:
Mailing address:
  • Phone: 708-828-9914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: