Provider Demographics
NPI:1225193683
Name:KUNTNER, LINDA LOU (PSYD)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LOU
Last Name:KUNTNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21859 W LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-9605
Mailing Address - Country:US
Mailing Address - Phone:847-223-9788
Mailing Address - Fax:847-548-4005
Practice Address - Street 1:21859 W LAKE DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-9605
Practice Address - Country:US
Practice Address - Phone:847-223-9788
Practice Address - Fax:847-548-4005
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL925000Medicare ID - Type Unspecified
ILR18128Medicare UPIN