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NPI Code Detail

MEDICARE: MS. VANIDA VESUNTIA LMFT

MEDICARE: MS. VANIDA VESUNTIA LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist166.001392IL

General Provider Information

NPI Number : 1801440953
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VANIDA VESUNTIA LMFT
Provider Business Mailing Address
First Line : 60 REVERE DR STE 100
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-1590
Country : US
Telephone Number : 224-306-1879
Fax Number : 224-306-1878
Provider Business Practice Location Address
First Line : 750 OAKMONT LN
Second Line :
City : WESTMONT
State : IL
Zip : 60559-5551
Country : US
Telephone Number : 877-552-6672
Fax Number : 224-306-1878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2019
Last Update Date : 03/27/2023

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