Provider Demographics
NPI:1225498389
Name:LAVICK-SCUDDER, VICTORIA R (LCPC)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:R
Last Name:LAVICK-SCUDDER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:R
Other - Last Name:LAVICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8801 W. PFEIFFER RD
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:IL
Mailing Address - Zip Code:61547
Mailing Address - Country:US
Mailing Address - Phone:309-550-9903
Mailing Address - Fax:800-554-2401
Practice Address - Street 1:8801 W. PFEIFFER RD
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:IL
Practice Address - Zip Code:61547
Practice Address - Country:US
Practice Address - Phone:309-550-9903
Practice Address - Fax:800-554-2401
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007740101YM0800X
IL25060101YA0400X
IL27266101YA0400X
IL180007740101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional