Provider Demographics
NPI:1720242993
Name:NIEPONSKI, MARY KATHERINE NONE (MA, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:MARY KATHERINE
Middle Name:NONE
Last Name:NIEPONSKI
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:16443 S PARKER RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9748
Mailing Address - Country:US
Mailing Address - Phone:708-262-7103
Mailing Address - Fax:866-596-8149
Practice Address - Street 1:33 E COLORADO AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1385
Practice Address - Country:US
Practice Address - Phone:708-262-7103
Practice Address - Fax:866-596-8149
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.003184101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional