Healthcare Provider Details

I. General information

NPI: 1255268231
Provider Name (Legal Business Name): VANESSA WHEATMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 W MADISON ST
CHICAGO IL
60602-4309
US

IV. Provider business mailing address

4333 N MCVICKER AVE
CHICAGO IL
60634-1634
US

V. Phone/Fax

Practice location:
  • Phone: 773-332-0641
  • Fax:
Mailing address:
  • Phone: 773-332-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.015119
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1128681
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: