Provider Demographics
NPI:1205126513
Name:IVANKOVICH, KARLA K (PHD, LCPC, NCC, BCPC)
Entity type:Individual
Prefix:DR
First Name:KARLA
Middle Name:K
Last Name:IVANKOVICH
Suffix:
Gender:F
Credentials:PHD, LCPC, NCC, BCPC
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:K
Other - Last Name:CARWILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1658 N MILWAUKEE AVE # 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6905
Mailing Address - Country:US
Mailing Address - Phone:312-527-6500
Mailing Address - Fax:800-281-6952
Practice Address - Street 1:5025 N PAULINA ST STE 325
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2772
Practice Address - Country:US
Practice Address - Phone:312-527-6500
Practice Address - Fax:800-281-6952
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004490101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor