Provider Demographics
NPI:1841991734
Name:RUDAUSKAS, NICHOLAS (MA, LPC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:RUDAUSKAS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 N KENMORE AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3724
Mailing Address - Country:US
Mailing Address - Phone:773-450-9720
Mailing Address - Fax:
Practice Address - Street 1:118 N CLINTON ST STE 440
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2392
Practice Address - Country:US
Practice Address - Phone:312-324-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL178.019127101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor