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General NPI Number Information
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NPI Number | 1508181793
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Entity Type | Organization
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Legal Business Name | STANEK AND ASSOCIATES COUNCELING SERVICE
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Dates
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Enumeration Date | 03/31/2010
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Last Update Date | 03/31/2010
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Provider Practice Location Address
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Address Line | 1127 S MANNHEIM RD SUITE 312
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City | WESTCHESTER
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State | IL
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Zip | 60154-2570
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Country | US
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Telephone | 708-924-1327
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Fax | 708-924-1328
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Provider Business Mailing Address
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Address Line | 7808 AMELIA CT SUITE 3B
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City | JUSTICE
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State | IL
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Zip | 60458-1393
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Country | US
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Telephone | 708-924-1327
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Fax | 708-924-1328
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH JON STANEK
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Credential | PHD
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Telephone | 708-924-1327
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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 | 1800000630
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License Number State | IL
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