Healthcare Provider Details

I. General information

NPI: 1023199262
Provider Name (Legal Business Name): KAREN J VATTHAUER LCPC, BCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N WEBSTER ST
TAYLORVILLE IL
62568-1258
US

IV. Provider business mailing address

PO BOX 194 800 N. WEBSTER ST.
TAYLORVILLE IL
62568-0194
US

V. Phone/Fax

Practice location:
  • Phone: 217-827-2877
  • Fax: 217-824-3451
Mailing address:
  • Phone: 217-827-2877
  • Fax: 217-824-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180001896
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: