Provider Demographics
NPI:1659838670
Name:ANDRESEN, KAORI I (LCPC BSP)
Entity Type:Individual
Prefix:
First Name:KAORI
Middle Name:I
Last Name:ANDRESEN
Suffix:
Gender:F
Credentials:LCPC BSP
Other - Prefix:
Other - First Name:KAORI
Other - Middle Name:
Other - Last Name:WANDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC BSP
Mailing Address - Street 1:231 S LASALLE ST
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604
Mailing Address - Country:US
Mailing Address - Phone:312-823-9594
Mailing Address - Fax:
Practice Address - Street 1:231 S LASALLE ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604
Practice Address - Country:US
Practice Address - Phone:312-823-9594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health