1811129471 NPI number — MRS. NORMA LEE CLASSEN MA, LCPC

Table of content: MRS. NORMA LEE CLASSEN MA, LCPC (NPI 1811129471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811129471 NPI number — MRS. NORMA LEE CLASSEN MA, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLASSEN
Provider First Name:
NORMA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARKER
Provider Other First Name:
NORMA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811129471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 CARLOCK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANFORTH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60930-6106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-861-9383
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 DEVONSHIRE DRIVE
Provider Second Line Business Practice Location Address:
C-22
Provider Business Practice Location Address City Name:
CHAMPAINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-861-9383
Provider Business Practice Location Address Fax Number:
217-398-0413
Provider Enumeration Date:
08/17/2009

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: 101YM0800X , with the licence number:  180006592 , 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)





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