Healthcare Provider Details

I. General information

NPI: 1538532908
Provider Name (Legal Business Name): KONICK AND ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2015
Last Update Date: 06/15/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S WASHINGTON ST STE 105
NAPERVILLE IL
60540-6665
US

IV. Provider business mailing address

600 S WASHINGTON ST STE 105
NAPERVILLE IL
60540-6665
US

V. Phone/Fax

Practice location:
  • Phone: 630-206-4060
  • Fax: 855-871-8351
Mailing address:
  • Phone: 630-206-4060
  • Fax: 855-871-8351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number071008083
License Number StateIL

VIII. Authorized Official

Name: DR. LISA C KONICK
Title or Position: PRESIDENT
Credential: PHD
Phone: 630-206-4060