MEDICARE: SCOTT C KAINOVIC LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1164155982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT C KAINOVIC LPC

Provider Business Mailing Address
First Line	:	1142 WHITE ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-6648
Country	:	US
Telephone Number	:	773-450-6626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-0851
Country	:	US
Telephone Number	:	618-507-5262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2022
Last Update Date	:	07/08/2022

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Directions to “ SCOTT C KAINOVIC LPC” Practice Location

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