Provider Demographics
NPI:1154965127
Name:KONDOUDIS, CECILY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CECILY
Middle Name:
Last Name:KONDOUDIS
Suffix:
Gender:
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:CECILY
Other - Middle Name:
Other - Last Name:HEUSNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:902 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2210
Mailing Address - Country:US
Mailing Address - Phone:618-326-2772
Mailing Address - Fax:618-937-1440
Practice Address - Street 1:902 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2210
Practice Address - Country:US
Practice Address - Phone:618-937-6483
Practice Address - Fax:618-937-1440
Is Sole Proprietor?:No
Enumeration Date:2019-11-03
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0247681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149024768OtherLCSW