Healthcare Provider Details

I. General information

NPI: 1760542484
Provider Name (Legal Business Name): KAREN NEKOLNY-SMITH PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6502 JOLIET RD STE 201
COUNTRYSIDE IL
60525
US

IV. Provider business mailing address

6502 JOLIET RD STE 201
COUNTRYSIDE IL
60525-4682
US

V. Phone/Fax

Practice location:
  • Phone: 708-215-8400
  • Fax: 708-215-8410
Mailing address:
  • Phone: 708-215-8400
  • Fax: 708-215-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-005093
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: