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General NPI Number Information
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NPI Number | 1225321052
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Entity Type | Individual
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Provider Name | HEIDI MCCARDELL-WENTWORTH LCPC, NCC, BC-DMT
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Gender | Female
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 1010 JORIE BLVD STE 366
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City | OAK BROOK
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State | IL
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Zip | 60523-4476
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Country | US
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Telephone | 630-849-4350
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 JORIE BLVD STE 366
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City | OAK BROOK
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State | IL
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Zip | 60523-4476
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Country | US
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Telephone | 630-849-4350
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Fax |
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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 | 225600000X
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Taxonomy Name | Dance Therapist
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License Number | 1203
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180010625
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 258132
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License Number State |
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