MEDICARE: MR. GARY EDWARD KUJAWA MS, LPC, NCC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1811531833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY EDWARD KUJAWA MS, LPC, NCC

Provider Business Mailing Address
First Line	:	5221 S NEWCASTLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-1103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20646 ABBEY WOODS CT N STE 205
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-3177
Country	:	US
Telephone Number	:	815-464-8210
Fax Number	:	815-464-8219

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

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	08/18/2020

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