Basic Information
| Provider Information | |||||||||
| NPI: | 1417466517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERZEL | ||||||||
| FirstName: | KAREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 CAPODICE RD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617055943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3095332755 | ||||||||
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| Practice Location | |||||||||
| Address1: | 706 OGLESBY AVE STE 111 | ||||||||
| Address2: | |||||||||
| City: | NORMAL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617614616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3095850241 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2017 | ||||||||
| LastUpdateDate: | 09/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 178013321 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.