Active NPI
Marilyn Joyce Fettner, LCPC
- Professional Counselor
- Northbrook, IL
National Provider Identifier
1104157890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.008430
- Practice address
- 910 Skokie Blvd
Suite 107
Northbrook, IL 60062-4013 - Phone
- (847) 831-0079
- NPI assigned
- Jan 20, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.008430 | IL | Primary |
Addresses
Primary practice location
910 Skokie Blvd
Suite 107
Northbrook, IL 60062-4013
Mailing address
1963 Skyelar CT
Highland Park, IL 60035-4322
Phone (847) 831-0079
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.008430 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356912000000",
"number": "1104157890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1963 SKYELAR CT",
"city": "HIGHLAND PARK",
"state": "IL",
"postal_code": "600354322",
"telephone_number": "847-831-0079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "910 SKOKIE BLVD",
"address_2": "SUITE 107",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600624013",
"telephone_number": "847-831-0079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETTNER",
"first_name": "MARILYN",
"middle_name": "JOYCE",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-20",
"last_updated": "2012-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.008430",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.