1720242993 NPI number — MRS. MARY KATHERINE NONE NIEPONSKI MA, LPC, NCC

Table of content: MRS. MARY KATHERINE NONE NIEPONSKI MA, LPC, NCC (NPI 1720242993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720242993 NPI number — MRS. MARY KATHERINE NONE NIEPONSKI MA, LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEPONSKI
Provider First Name:
MARY KATHERINE
Provider Middle Name:
NONE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720242993
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16443 S PARKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMER GLEN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60491-9748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-262-7103
Provider Business Mailing Address Fax Number:
866-596-8149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 E COLORADO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60423-1385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-262-7103
Provider Business Practice Location Address Fax Number:
866-596-8149
Provider Enumeration Date:
07/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  178.003184 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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