# PKC HEALTH SERVICE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PKC Health Service
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902658586
- **Authorized official:** LASHONDA CROCKETT (PRESIDENT)
- **Authorized official phone:** (708) 303-8816

## Contact information

- **Practice address:** 1521 OTTO BLVD, CHICAGO HEIGHTS, IL 60411-3875
- **Practice address phone:** (708) 303-8816
- **Mailing address:** 18300 S HALSTED STE B \#341, GLENWOOD, IL 60425
- **Mailing address phone:** (708) 303-8816

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 2084P0301X | Brain Injury Medicine (Psychiatry & Neurology) Physician | — | — | Yes |
| 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