Individual
JAMES JOHN KOTLEBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LIC CLINICAL PSYCHOL
Contact information
Practice address
745 S 8TH ST, WEST DUNDEE, IL 60118-3602
(800) 428-7260
(847) 428-7269
Mailing address
745- S 8TH ST, W. DUNDEE, IL 60118
(847) 428-7260
(847) 428-7269
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071-002484
IL
103TC0700X
Clinical Psychologist
071002484
IL
Other
Enumeration date
02/18/2011
Last updated
12/13/2011
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