Provider Demographics
NPI:1548548092
Name:KONICK, LISA CALLIO (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:CALLIO
Last Name:KONICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S WASHINGTON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6665
Mailing Address - Country:US
Mailing Address - Phone:630-206-4060
Mailing Address - Fax:855-871-8351
Practice Address - Street 1:600 S WASHINGTON ST STE 105
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6665
Practice Address - Country:US
Practice Address - Phone:630-206-4060
Practice Address - Fax:855-871-8351
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL07008083103TB0200X
IL071008083103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent