NPIMap

Organization Active NPI

PKC Health Service

  • Brain Injury Medicine (Psychiatry & Neurology) Physician
  • Chicago Heights, IL
National Provider Identifier
1902658586
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Brain Injury Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084P0301X
Legal business name
PKC HEALTH SERVICE
Doing business as
PKC Health Service
Practice address
1521 Otto Blvd
Chicago Heights, IL 60411-3875
Phone
(708) 303-8816
NPI assigned
Apr 4, 2024
Last updated
Sep 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lashonda CrockettNPI 1942199344
Title
President
Phone
(708) 303-8816

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Clinical Neuropsychologist 103G00000X NU
Psychologist 103T00000X NU
Art Therapist 221700000X NU
Physical Therapist 225100000X NU
Recreation Therapist 225800000X NU
Music Therapist 225A00000X NU
Speech-Language Pathologist 235Z00000X NU
Behavioral Neurology & Neuropsychiatry Physician 2084B0040X NU
Behavior Analyst 103K00000X NU
In Home Supportive Care Agency 253Z00000X NU
Community/Behavioral Health Agency 251S00000X NU
Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician 2081P0301X NU
Brain Injury Medicine (Psychiatry & Neurology) Physician 2084P0301X NU Primary
Drama Therapist 101200000X NU

Addresses

Primary practice location

1521 Otto Blvd
Chicago Heights, IL 60411-3875

Mailing address

18300 S Halsted Ste B #341
Glenwood, IL 60425
Phone (708) 303-8816

Other names 1

  • PKC Health Service Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1902658586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18300 S HALSTED STE B #341",
            "city": "GLENWOOD",
            "state": "IL",
            "postal_code": "60425",
            "telephone_number": "708-303-8816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 OTTO BLVD",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604113875",
            "telephone_number": "708-303-8816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PKC HEALTH SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-04",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "CROCKETT",
        "authorized_official_first_name": "LASHONDA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-303-8816"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "221700000X",
            "taxonomy_group": "",
            "desc": "Art Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225800000X",
            "taxonomy_group": "",
            "desc": "Recreation Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225A00000X",
            "taxonomy_group": "",
            "desc": "Music Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2081P0301X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Brain Injury Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0301X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Brain Injury Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101200000X",
            "taxonomy_group": "",
            "desc": "Drama Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PKC Health Service",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PKC Health Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.