Individual
DR. SHANTA KANUKOLLU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
10201 S CICERO AVE, OAK LAWN, IL 60453-4098
(847) 377-4496
Mailing address
10201 S CICERO AVE, OAK LAWN, IL 60453-4098
(847) 377-4496
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.008400
IL
Other
Enumeration date
05/29/2015
Last updated
05/29/2015
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