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Organization
PKC HEALTH SERVICE
Active
Organization
PKC HEALTH SERVICE
Active
Other names
PKC Health Service
Organization subpart
No
Provider details
NPI number
Authorized official
LASHONDA CROCKETT (PRESIDENT)
(708) 303-8816
Entity
Organization
Contact information
Practice address
1521 OTTO BLVD, CHICAGO HEIGHTS, IL 60411-3875
(708) 303-8816
Mailing address
18300 S HALSTED STE B #341, GLENWOOD, IL 60425
(708) 303-8816
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
—
NULL
101200000X
Drama Therapist
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
103G00000X
Clinical Neuropsychologist
—
NULL
103G00000X
Clinical Neuropsychologist
—
—
103K00000X
Behavior Analyst
—
NULL
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
2081P0301X
Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081P0301X
Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
NULL
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
—
2084P0301X
Brain Injury Medicine (Psychiatry & Neurology) Physician
Primary
—
NULL
2084P0301X
Brain Injury Medicine (Psychiatry & Neurology) Physician
Primary
—
—
221700000X
Art Therapist
—
NULL
221700000X
Art Therapist
—
—
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
225800000X
Recreation Therapist
—
NULL
225800000X
Recreation Therapist
—
—
225A00000X
Music Therapist
—
NULL
225A00000X
Music Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
251S00000X
Community/Behavioral Health Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
Other
Enumeration date
04/04/2024
Last updated
09/26/2024
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