Provider Demographics
NPI:1124482302
Name:DUEHOLM, KERRY (LPC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:DUEHOLM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25285 W IVANHOE RD
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-2405
Mailing Address - Country:US
Mailing Address - Phone:773-301-6428
Mailing Address - Fax:
Practice Address - Street 1:1000 HART RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2659
Practice Address - Country:US
Practice Address - Phone:847-382-4683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional