Healthcare Provider Details

I. General information

NPI: 1528571718
Provider Name (Legal Business Name): DANIELLE SLYDER LCPC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N 11TH AVE STE 106
SAINT CHARLES IL
60174-2278
US

IV. Provider business mailing address

1120 RANDALL CT
GENEVA IL
60134-3911
US

V. Phone/Fax

Practice location:
  • Phone: 630-296-4169
  • Fax:
Mailing address:
  • Phone: 224-236-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number22-201
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.013250
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: