Provider Demographics
NPI:1376428508
Name:JK SOMATIC THERAPY, LLC
Entity type:Organization
Organization Name:JK SOMATIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:CORINNE
Authorized Official - Last Name:KOROTKO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-683-2781
Mailing Address - Street 1:5145 N LOVEJOY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2235
Mailing Address - Country:US
Mailing Address - Phone:312-339-6056
Mailing Address - Fax:
Practice Address - Street 1:5419 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3686
Practice Address - Country:US
Practice Address - Phone:773-683-2781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1245521780OtherNPI