LISA N VANDERMARK Social Worker License verification

Business Entity

INACTIVE

License Type

Social Worker

Description

LICENSED CLINICAL SOCIAL WORKER

License Number

149010364

License Status

INACTIVE

Business

First Name

LISA

Middle

Last Name

VANDERMARK

Business Name

LISA N VANDERMARK

Original Issue Date

12/31/2002

Effective Date

11/20/2003

Expiration Date

11/30/2003

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Specialty/Qualifier

MASTERS

Ever Disciplined

LastModifiedDate

12/16/2005