Provider Demographics
NPI:1598834699
Name:VEON, KENNETH (LCPC CADC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:VEON
Suffix:
Gender:M
Credentials:LCPC CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 FEDERAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526
Mailing Address - Country:US
Mailing Address - Phone:217-872-1003
Mailing Address - Fax:217-233-4150
Practice Address - Street 1:2570 FEDERAL DRIVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-872-1003
Practice Address - Fax:217-233-4150
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003510101YA0400X
IL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
05821971OtherBCBS
200908Medicare ID - Type UnspecifiedSUPERVISED