Kimberly M Antos-Hogan, MA,LCPC, CRC,
Individual provider Active NPI Professional Counselor · Glen Ellyn, IL
NPI 1780192724 · NPPES record last updated Jan 11, 2018
Key facts
- NPI
- 1780192724
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 180000743 (IL)
- Practice address
- 21W675 Dorchester CT
Glen Ellyn, IL 60137-6411 - Phone
- (630) 740-8559
- Fax
- (630) 740-8559
- NPI assigned
- Jan 11, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180000743 | IL | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | 180000743 | IL | Yes |
Addresses
Primary practice location
21W675 Dorchester CT
Glen Ellyn, IL 60137-6411
Mailing address
21W675 Dorchester CT
Glen Ellyn, IL 60137-6411
Phone (630) 858-7030
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15655 | Other | IL | BOARD CERTIFIED PROFESSIONAL COUNSELOR |
| 00007720 | Other | IL | CERTIFIED REHABILITATION COUNSELOR |
| 180000743 | Other | IL | COUNSELOR |
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- Katrina Marie Appiah
- Jocelyn S Arackal
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All providers in Glen Ellyn, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.