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General NPI Number Information
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NPI Number | 1194799312
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Entity Type | Individual
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Provider Name | LISA C. MEDANIC L.C.P.C.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 29W120 BUTTERFIELD RD STE 104A
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City | WARRENVILLE
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State | IL
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Zip | 60555-2830
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Country | US
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Telephone | 630-393-4019
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Fax | 630-904-9871
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Provider Business Mailing Address
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Address Line | 3126 CRYSTAL ROCK RD
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City | NAPERVILLE
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State | IL
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Zip | 60564-8241
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Country | US
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Telephone | 630-904-9230
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Fax | 630-904-9871
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | IL
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