Provider Demographics
NPI:1699334037
Name:AHERN, PATRICIA RAE (LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RAE
Last Name:AHERN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10635 S HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3127
Mailing Address - Country:US
Mailing Address - Phone:773-445-3220
Mailing Address - Fax:
Practice Address - Street 1:18154 MARTIN AVE STE 2
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2155
Practice Address - Country:US
Practice Address - Phone:708-929-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional