Healthcare Provider Details

I. General information

NPI: 1225809346
Provider Name (Legal Business Name): VLASTA KUDINA LPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 W CHICAGO AVE
CHICAGO IL
60642-5236
US

IV. Provider business mailing address

2735 HASSERT BLVD # 135-301
NAPERVILLE IL
60564-5204
US

V. Phone/Fax

Practice location:
  • Phone: 312-339-8604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178019790
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: