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KENNETH VICENCIO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSYD

Contact information

Practice address
10730 W 143RD ST STE 37, ORLAND PARK, IL 60462-1940
(800) 564-0863
Mailing address
10730 W 143RD ST STE 37, ORLAND PARK, IL 60462-1940
(800) 564-0863

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
071009682
IL
103G00000X
Clinical Neuropsychologist

Other

Enumeration date
08/22/2017
Last updated
09/27/2022
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