Provider Demographics
NPI:1861941767
Name:KODROFF, SLOAN W (MA CMHC, LCPC)
Entity type:Individual
Prefix:MR
First Name:SLOAN
Middle Name:W
Last Name:KODROFF
Suffix:
Gender:M
Credentials:MA CMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 E CONSTITUTION DR APT 5
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-1932
Mailing Address - Country:US
Mailing Address - Phone:847-917-4610
Mailing Address - Fax:
Practice Address - Street 1:2101 S ARLINGTON HEIGHTS RD STE 116
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4142
Practice Address - Country:US
Practice Address - Phone:847-666-5339
Practice Address - Fax:847-637-5479
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011053101YP2500X
IL180.010819101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional