Provider Demographics
NPI:1396084646
Name:VODNIK, CARRIE ELIZABETH (LPC)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:VODNIK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:CARRIE
Other - Middle Name:ELIZABETH
Other - Last Name:FATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1601 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3123
Mailing Address - Country:US
Mailing Address - Phone:708-373-6194
Mailing Address - Fax:
Practice Address - Street 1:3033 W JEFFERSON ST STE 107
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5298
Practice Address - Country:US
Practice Address - Phone:815-773-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007116101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor