Provider Demographics
NPI:1811531833
Name:KUJAWA, GARY EDWARD (MS, LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:EDWARD
Last Name:KUJAWA
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 S NEWCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-1103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20646 ABBEY WOODS CT N STE 205
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3177
Practice Address - Country:US
Practice Address - Phone:815-464-8210
Practice Address - Fax:815-464-8219
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty