MEDICARE: KENNETH D RICHMOND

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
1	101YM0800X	Mental Health Counselor	150111927	IL

General Provider Information

NPI Number	:	1558101048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH D RICHMOND

Provider Business Mailing Address
First Line	:	1922 S TROY ST APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-2294
Country	:	US
Telephone Number	:	646-276-4825
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 N MILWAUKEE AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2009
Country	:	US
Telephone Number	:	773-386-6510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	05/31/2024

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Directions to “ KENNETH D RICHMOND ” Practice Location

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