Doctor Name: | DIANE LORRAINE SIRI |
NPI Number: | 1033390836 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180006685 |
Business Practice Address: | 109 S Main St Wauconda, IL - 600841825 |
Business Phone Number: | 8473371667 |
Business Fax Number: | 2247958920 |
Mailing Address: | 109 S Main St, WAUCONDA |
State: | IL |
Postal Code: | 600841825 |
Phone Number: | 8473371667 |
Fax Number: | 2247958920 |
NPI Enumeration Date: | 11/20/2007 |
NPI Last Update Date: | 10/31/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180006685 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |