| Doctor Name: | LISA C. MEDANIC |
| NPI Number: | 1194799312 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.C.P.C. |
| License Number: | |
| Business Practice Address: | 29w120 Butterfield Rd Ste 104a Warrenville, IL - 605552830 |
| Business Phone Number: | 6303934019 |
| Business Fax Number: | 6309049871 |
| Mailing Address: | 3126 Crystal Rock Rd, NAPERVILLE |
| State: | IL |
| Postal Code: | 605648241 |
| Phone Number: | 6309049230 |
| Fax Number: | 6309049871 |
| NPI Enumeration Date: | 02/14/2006 |
| NPI Last Update Date: | 12/13/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |