Provider Demographics
NPI:1205956380
Name:LAJEUNESSE, KATHLEEN A (LCPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:LAJEUNESSE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:LAJEUNESSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:319 LEEDS CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2448
Mailing Address - Country:US
Mailing Address - Phone:630-983-5025
Mailing Address - Fax:630-653-1010
Practice Address - Street 1:300 E 5TH AVE
Practice Address - Street 2:SUITE 265
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3177
Practice Address - Country:US
Practice Address - Phone:630-527-1778
Practice Address - Fax:630-653-1010
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02233105OtherBLUE CROSS BLUE SHIELS IL