Provider Demographics
NPI:1538211776
Name:GANSTER, GLENNA R (LCPC)
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:R
Last Name:GANSTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1N141 COUNTY FARM RD
Mailing Address - Street 2:STE. 120
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2032
Mailing Address - Country:US
Mailing Address - Phone:630-221-1909
Mailing Address - Fax:
Practice Address - Street 1:1N141 COUNTY FARM RD
Practice Address - Street 2:STE. 120
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2032
Practice Address - Country:US
Practice Address - Phone:630-221-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
02232842OtherBLUE CROSS BLUE SHIELD NO