Provider Demographics
NPI:1760171722
Name:KIPNIS, FRADINE L (LPC)
Entity Type:Individual
Prefix:MS
First Name:FRADINE
Middle Name:L
Last Name:KIPNIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 OVERLAND TRL
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1811
Mailing Address - Country:US
Mailing Address - Phone:847-409-6966
Mailing Address - Fax:
Practice Address - Street 1:1715 OVERLAND TRL
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-1811
Practice Address - Country:US
Practice Address - Phone:847-409-6966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.004497101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor