Basic Information
| Provider Information | |||||||||
| NPI: | 1538667084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POJSKIC | ||||||||
| FirstName: | KENAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4753 N BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606405266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732938430 | ||||||||
| FaxNumber: | 7737284751 | ||||||||
| Practice Location | |||||||||
| Address1: | 990 GROVE ST | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602016510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887267170 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2018 | ||||||||
| LastUpdateDate: | 02/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 166001445 | IL | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.