Provider Demographics
NPI:1104004142
Name:KNAPCZYK, KELLY KATHLEEN (LCPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KATHLEEN
Last Name:KNAPCZYK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:KATHLEEN
Other - Last Name:DURNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4321 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2617
Mailing Address - Country:US
Mailing Address - Phone:708-499-8033
Mailing Address - Fax:708-433-8033
Practice Address - Street 1:4321 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2617
Practice Address - Country:US
Practice Address - Phone:708-499-8033
Practice Address - Fax:708-499-8033
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional