Healthcare Provider Details

I. General information

NPI: 1447985478
Provider Name (Legal Business Name): DAWN SUSANNE REICH LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 MAIN ST
OSWEGO IL
60543-9893
US

IV. Provider business mailing address

309 MILLINGTON WAY
SAINT CHARLES IL
60174-5528
US

V. Phone/Fax

Practice location:
  • Phone: 630-519-1010
  • Fax:
Mailing address:
  • Phone: 630-200-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180014553
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: