Provider Demographics
NPI:1770820573
Name:ANDJULIS, KENNETH MICHAEL (LCPC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MICHAEL
Last Name:ANDJULIS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 N ASHLAND AVE
Mailing Address - Street 2:SUITE 205-A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4027
Mailing Address - Country:US
Mailing Address - Phone:312-806-6918
Mailing Address - Fax:
Practice Address - Street 1:5701 N ASHLAND AVE
Practice Address - Street 2:SUITE 205-A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4027
Practice Address - Country:US
Practice Address - Phone:312-806-6918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional