1720305618 NPI number — MRS. LINDA SUE RECKERS MA

Table of content: MRS. LINDA SUE RECKERS MA (NPI 1720305618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720305618 NPI number — MRS. LINDA SUE RECKERS MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RECKERS
Provider First Name:
LINDA
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RECKERS
Provider Other First Name:
LINDA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720305618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5325 FAIRMOUNT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-5057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-963-3246
Provider Business Mailing Address Fax Number:
630-963-3246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5325 FAIRMOUNT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNERS GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60515-5057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-963-3246
Provider Business Practice Location Address Fax Number:
630-963-3246
Provider Enumeration Date:
05/01/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  180-003389 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)