Active NPI
Oktawia Kruk
- Professional Counselor
- McHenry, IL
National Provider Identifier
1871026955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178012469
- Practice address
- 5400 W Elm St Ste 104
McHenry, IL 60050-4032 - Phone
- (815) 331-8768
- Fax
- (815) 331-8760
- NPI assigned
- Apr 6, 2017
- Last updated
- Apr 6, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178012469 | IL | Primary |
Addresses
Primary practice location
5400 W Elm St Ste 104
McHenry, IL 60050-4032
Mailing address
436 Ferndale CT
Buffalo Grove, IL 60089-1730
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178012469 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| FJ Psychological Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Volo, IL
- NPI 1730606575
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491436800000",
"number": "1871026955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "436 FERNDALE CT",
"city": "BUFFALO GROVE",
"state": "IL",
"postal_code": "600891730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5400 W ELM ST STE 104",
"city": "MCHENRY",
"state": "IL",
"postal_code": "600504032",
"telephone_number": "815-331-8768",
"fax_number": "815-331-8760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUK",
"first_name": "OKTAWIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-06",
"last_updated": "2017-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178012469",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McHenry, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.