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General NPI Number Information
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NPI Number | 1497284996
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Entity Type | Organization
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Legal Business Name | PKK SERVICES INC.
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3380 LACROSSE LN STE 101
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City | NAPERVILLE
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State | IL
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Zip | 60564-8528
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Country | US
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Telephone | 630-234-0466
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Fax | 630-216-6223
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Provider Business Mailing Address
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Address Line | 3380 LACROSSE LN STE 101
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City | NAPERVILLE
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State | IL
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Zip | 60564-8528
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Country | US
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Telephone | 630-234-0466
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Fax | 630-216-6223
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Authorized Official
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Title or Position | OWNER/CLINICAL THERAPIST
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Name | DR. PAIGE KENDALL KOOS
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Credential | EDD, LCSW
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Telephone | 630-234-0466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-007322
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License Number State | IL
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