Provider Demographics
NPI:1588108542
Name:RAMIREZ, MARILYN (MS ED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MS ED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5334 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-7320
Mailing Address - Country:US
Mailing Address - Phone:815-243-0739
Mailing Address - Fax:
Practice Address - Street 1:5334 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073
Practice Address - Country:US
Practice Address - Phone:815-243-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012545101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178.012545Medicaid