Provider Demographics
NPI:1184382566
Name:KANDA THERAPY INC
Entity type:Organization
Organization Name:KANDA THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, LCSW
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAATJES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RPLAYTHERAPIST
Authorized Official - Phone:815-421-9131
Mailing Address - Street 1:9200 W 191ST ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8730
Mailing Address - Country:US
Mailing Address - Phone:815-421-9131
Mailing Address - Fax:
Practice Address - Street 1:9200 W 191ST ST STE 6
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8730
Practice Address - Country:US
Practice Address - Phone:815-421-9131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740001OtherPSYCHEALTH
2389816OtherCOMPSYCH