Individual
CORY NIETZKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5547 N RAVENSWOOD AVE, CHICAGO, IL 60640-1125
(773) 818-0495
(773) 769-1476
Mailing address
5547 N RAVENSWOOD AVE, CHICAGO, IL 60640-1125
(773) 818-0495
(773) 769-1476
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0178.005724
IL
Other
Enumeration date
11/18/2013
Last updated
11/18/2013
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