Provider Demographics
NPI:1891263281
Name:KANIEWSKI, LORI (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:KANIEWSKI
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10212 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9682
Mailing Address - Country:US
Mailing Address - Phone:847-373-0408
Mailing Address - Fax:
Practice Address - Street 1:9241 S IL ROUTE 31
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-1607
Practice Address - Country:US
Practice Address - Phone:847-854-4333
Practice Address - Fax:847-854-4334
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional