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General NPI Number Information
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NPI Number | 1518454081
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Entity Type | Individual
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Provider Name | ALEKS KICO
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Gender | Male
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 2525 WAUKEGAN RD STE 295
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City | BANNOCKBURN
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State | IL
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Zip | 60015-5507
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Country | US
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Telephone | 847-577-1501
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 TOPP LN APT 8
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City | GLENVIEW
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State | IL
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Zip | 60025-2129
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Country | US
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Telephone | 872-235-5410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 149020247
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License Number State | IL
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