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NPI Code Detail

MEDICARE: MS. KELLI POLO LCPC

MEDICARE: MS. KELLI POLO LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor180009220IL

General Provider Information

NPI Number : 1104772854
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLI POLO LCPC
Provider Business Mailing Address
First Line : 2800 S CALIFORNIA AVE
Second Line : CERMAK HEALTH SERVICES - MENTAL HEALTH DEPARTMENT
City : CHICAGO
State : IL
Zip : 60608-5107
Country : US
Telephone Number : 312-215-6435
Fax Number :
Provider Business Practice Location Address
First Line : 2800 S CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-5107
Country : US
Telephone Number : 773-674-2470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2026
Last Update Date : 03/12/2026

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