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General NPI Number Information
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NPI Number | 1538612866
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Entity Type | Individual
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Provider Name | HEATHER VAGLE LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 02/11/2023
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Provider Practice Location Address
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Address Line | 1411 N KICKAPOO ST STE 227
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City | LINCOLN
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State | IL
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Zip | 62656-1800
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Country | US
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Telephone | 309-886-5038
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Fax |
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Provider Business Mailing Address
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Address Line | 10 PALM CT
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City | BLOOMINGTON
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State | IL
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Zip | 61701-7820
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Country | US
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Telephone | 612-242-2685
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.010901
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License Number State | IL
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