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General NPI Number Information
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NPI Number | 1912038910
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Entity Type | Individual
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Provider Name | RAYMOND C. WUNDERLICH JR. L.C.P.C.
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 4160 IL ROUTE 83 STE 204
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City | LONG GROVE
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State | IL
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Zip | 60047-8034
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Country | US
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Telephone | 847-380-4806
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Fax |
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Provider Business Mailing Address
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Address Line | 318 W HALF DAY RD PMB 284
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-6547
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Country | US
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Telephone | 847-380-4806
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180-002811
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License Number State | IL
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