Provider Demographics
NPI:1972773737
Name:SEMENIK, MANDY ANN (MS, LCPC)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:ANN
Last Name:SEMENIK
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13020 W SPLIT RAIL CT
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8164
Mailing Address - Country:US
Mailing Address - Phone:708-309-0313
Mailing Address - Fax:
Practice Address - Street 1:13020 W SPLIT RAIL CT
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8164
Practice Address - Country:US
Practice Address - Phone:708-309-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-08
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005132101YM0800X
IL180.007939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health