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General NPI Number Information
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NPI Number | 1760542484
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Entity Type | Individual
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Provider Name | KAREN NEKOLNY-SMITH PSY. D.
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 6502 JOLIET RD STE 201
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City | COUNTRYSIDE
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State | IL
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Zip | 60525
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Country | US
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Telephone | 708-215-8400
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Fax | 708-215-8410
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Provider Business Mailing Address
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Address Line | 6502 JOLIET RD STE 201
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-4682
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Country | US
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Telephone | 708-215-8400
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Fax | 708-215-8410
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-005093
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License Number State | IL
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