Provider Demographics
NPI:1356454367
Name:KIZHAKEDAN, JOHN P (LCPC, CEAP, SAP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:KIZHAKEDAN
Suffix:
Gender:M
Credentials:LCPC, CEAP, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 W JEFFERSON ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5261
Mailing Address - Country:US
Mailing Address - Phone:815-773-6277
Mailing Address - Fax:708-563-9381
Practice Address - Street 1:3033 W JEFFERSON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5261
Practice Address - Country:US
Practice Address - Phone:815-773-6277
Practice Address - Fax:708-563-9381
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
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