Healthcare Provider Details

I. General information

NPI: 1265869986
Provider Name (Legal Business Name): KAREN VACHULCIK LCPC, NCC, CADC, BCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13235 W HIAWATHA DR
HOMER GLEN IL
60491-8637
US

IV. Provider business mailing address

13235 HIAWATHA DRIVE
HOMER GLEN IL
60491-8637
US

V. Phone/Fax

Practice location:
  • Phone: 847-927-2441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180008797
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30730
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: