Provider Demographics
NPI:1487705133
Name:COTTON, MARIANNE C (MA, LCPC)
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:C
Last Name:COTTON
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:C
Other - Last Name:KELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCPC
Mailing Address - Street 1:1432 SAGE DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-3217
Mailing Address - Country:US
Mailing Address - Phone:708-539-5685
Mailing Address - Fax:
Practice Address - Street 1:519 N CASS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1514
Practice Address - Country:US
Practice Address - Phone:630-541-9560
Practice Address - Fax:630-541-8381
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional