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NPI Code Detail

MEDICARE: KANIKA SHUKUL, LCPC, LLC

MEDICARE: KANIKA SHUKUL, LCPC, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)180009713IL

General Provider Information

NPI Number : 1467967760
Entity Type Code : Organization
Provider Name (Legal Business Name) : KANIKA SHUKUL, LCPC, LLC
Provider Business Mailing Address
First Line : 4707 N BROADWAY ST STE 200
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4999
Country : US
Telephone Number : 773-832-7878
Fax Number : 773-832-7878
Provider Business Practice Location Address
First Line : 4707 N BROADWAY ST STE 200
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4999
Country : US
Telephone Number : 773-832-7878
Fax Number : 773-832-7878
Authorized Official
Title or Position : LICENSED CLINICAL PROFESSIONAL COUN
Name : KANIKA NAVNEET SHUKUL
Credential :
Telephone Number : 773-832-7878
Provider Enumeration Date : 12/08/2017
Last Update Date : 11/14/2018

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