Individual
KENNETH KUBICEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, LCPC
Contact information
Practice address
3 OAK DR STE B, MARYVILLE, IL 62062-5635
(618) 972-1568
(618) 205-3561
Mailing address
3 OAK DR STE B, MARYVILLE, IL 62062-5635
(618) 972-1568
(618) 205-3561
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
180.002041
IL
Other
Enumeration date
09/15/2023
Last updated
09/15/2023
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