Provider Demographics
NPI:1053960336
Name:MLADIC, EMILIANA (MA, LCPC)
Entity type:Individual
Prefix:
First Name:EMILIANA
Middle Name:
Last Name:MLADIC
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 RAVINE WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7615
Mailing Address - Country:US
Mailing Address - Phone:847-730-3042
Mailing Address - Fax:
Practice Address - Street 1:2400 RAVINE WAY STE 600
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7615
Practice Address - Country:US
Practice Address - Phone:847-730-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012406101YM0800X
IL180.014369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health