Healthcare Provider Details

I. General information

NPI: 1154684652
Provider Name (Legal Business Name): KANIKA NAVNEET SHUKUL LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 N CLARK ST STE 220
CHICAGO IL
60640-1272
US

IV. Provider business mailing address

5412 N CLARK ST STE 220
CHICAGO IL
60640-1272
US

V. Phone/Fax

Practice location:
  • Phone: 773-606-5303
  • Fax:
Mailing address:
  • Phone: 773-606-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180009713
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: