Individual
MR. LAZAR KIZHAKEDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW, CADC
Contact information
Practice address
3033 W JEFFERSON ST, SUITE 205, JOLIET, IL 60435-5261
(815) 773-6277
Mailing address
3 H WILDWOOD LN, BOLINGBROOK, IL 60440-1943
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
29480
IL
104100000X
Social Worker
Primary
150.012857
IL
Other
Enumeration date
01/10/2012
Last updated
01/10/2012
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