Individual
MR. FREDRICK WACKENHUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2400 RAVINE WAY STE 600, GLENVIEW, IL 60025-7615
(847) 730-3042
Mailing address
2431 ROCKPORT RD, HAMPSHIRE, IL 60140-9065
(773) 710-4526
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
178.016446
IL
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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