Individual
KENNETH ADAM FOGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY D
Contact information
Practice address
200 S FRONTAGE RD STE 324, BURR RIDGE, IL 60527-6953
(847) 347-0491
Mailing address
118 N CHESTER AVE, PARK RIDGE, IL 60068
(847) 384-5679
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071006356
IL
Other
Enumeration date
08/13/2006
Last updated
01/08/2021
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