Provider Demographics
NPI:1982193108
Name:POLIGNONE, NINA (LPC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:POLIGNONE
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 1:15127 S 73RD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4398
Mailing Address - Country:US
Mailing Address - Phone:708-586-9303
Mailing Address - Fax:
Practice Address - Street 1:15127 S 73RD AVE STE C
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3463
Practice Address - Country:US
Practice Address - Phone:630-225-8604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IL178.016939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician