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General NPI Number Information
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NPI Number | 1396405353
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Entity Type | Individual
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Provider Name | EDWIN VIGLIA III LPC
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Gender | Male
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Dates
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Enumeration Date | 12/17/2021
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 755 ALMAR PKWY
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2392
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Country | US
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Telephone | 815-216-8029
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 S MYRTLE AVE
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City | KANKAKEE
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State | IL
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Zip | 60901-5458
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Country | US
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Telephone | 815-216-8029
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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 | 178.017366
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License Number State | IL
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