Provider Demographics
NPI:1760774509
Name:NIKONIUK, PREMLATA (LPC, LCPC, NCC CCMHC)
Entity Type:Individual
Prefix:
First Name:PREMLATA
Middle Name:
Last Name:NIKONIUK
Suffix:
Gender:F
Credentials:LPC, LCPC, NCC CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 LAUREL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-3316
Mailing Address - Country:US
Mailing Address - Phone:630-965-0361
Mailing Address - Fax:
Practice Address - Street 1:1644 W COLONIAL PKWY
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-1207
Practice Address - Country:US
Practice Address - Phone:847-776-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK691101YP2500X
IL180007642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional