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General NPI Number Information
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NPI Number | 1336537745
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Entity Type | Individual
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Provider Name | PHETSAVANH COGGIN LCPC
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Gender | Female
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 3701 DOTY RD
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City | WOODSTOCK
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State | IL
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Zip | 60098
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Country | US
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Telephone | 815-338-6600
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Fax | 815-206-5376
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Provider Business Mailing Address
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Address Line | 47 KATRINA LN
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City | SLEEPY HOLLOW
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State | IL
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Zip | 60118-3123
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180010325
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 1001080
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License Number State | IL
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