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General NPI Number Information
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NPI Number | 1376428508
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Entity Type | Organization
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Legal Business Name | JK SOMATIC THERAPY, LLC
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 5419 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3686
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Country | US
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Telephone | 773-683-2781
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Fax |
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Provider Business Mailing Address
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Address Line | 5145 N LOVEJOY AVE
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City | CHICAGO
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State | IL
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Zip | 60630-2235
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Country | US
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Telephone | 312-339-6056
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENIFER CORINNE KOROTKO
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Credential | LCPC
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Telephone | 773-683-2781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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