Provider Demographics
NPI:1770602427
Name:HALLAS, KENNETH S (LCSW)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:S
Last Name:HALLAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7527 KENTON AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3839
Mailing Address - Country:US
Mailing Address - Phone:847-323-8280
Mailing Address - Fax:
Practice Address - Street 1:906 DAVIS ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3608
Practice Address - Country:US
Practice Address - Phone:847-492-1778
Practice Address - Fax:847-492-0320
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical