Provider Demographics
NPI:1851716047
Name:JAMES, KENNETH WILLIAM (PHD, IAAP)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WILLIAM
Last Name:JAMES
Suffix:
Gender:M
Credentials:PHD, IAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 W POLK ST STE 100-174
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2000
Mailing Address - Country:US
Mailing Address - Phone:773-983-5448
Mailing Address - Fax:
Practice Address - Street 1:124 W POLK ST
Practice Address - Street 2:101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1784
Practice Address - Country:US
Practice Address - Phone:773-983-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001219101YP2500X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional