Individual
GARY KANIUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1901 W HARRISON ST, CHICAGO, IL 60612-3714
(773) 869-7602
Mailing address
10206 KEDVALE AVE, OAK LAWN, IL 60453-4240
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-004656
IL
Other
Enumeration date
04/03/2007
Last updated
04/26/2021
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