Provider Demographics
NPI:1477083392
Name:SNK THERAPY LLC
Entity Type:Organization
Organization Name:SNK THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTA
Authorized Official - Middle Name:NISHI
Authorized Official - Last Name:KANUKOLLU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-270-2360
Mailing Address - Street 1:500 N MICHIGAN AVE STE 1042
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3783
Mailing Address - Country:US
Mailing Address - Phone:773-270-2360
Mailing Address - Fax:
Practice Address - Street 1:500 N MICHIGAN AVE STE 1042
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3783
Practice Address - Country:US
Practice Address - Phone:773-270-2360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health