Provider Demographics
NPI:1386758522
Name:AHRENS, KEVIN WILLIAM (MSED, LCPC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:WILLIAM
Last Name:AHRENS
Suffix:
Gender:M
Credentials:MSED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W BARTLETT AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-7880
Mailing Address - Country:US
Mailing Address - Phone:630-837-5303
Mailing Address - Fax:630-837-5305
Practice Address - Street 1:106 W BARTLETT AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-7880
Practice Address - Country:US
Practice Address - Phone:630-837-5303
Practice Address - Fax:630-837-5305
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002225381OtherBLUE CROSS BLUE SHIELD