Provider Demographics
NPI:1598036386
Name:JANKOWSKI, KYLE JOSEPH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:JOSEPH
Last Name:JANKOWSKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11S230 SOUTH JACKSON ST.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527
Mailing Address - Country:US
Mailing Address - Phone:773-558-8500
Mailing Address - Fax:630-560-4979
Practice Address - Street 1:11S230 SOUTH JACKSON ST.
Practice Address - Street 2:SUITE 104
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527
Practice Address - Country:US
Practice Address - Phone:773-558-8500
Practice Address - Fax:630-560-4979
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
IL1490153811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical