MEDICARE: MRS. KIM ELLEN MCKINNEY

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	1041C0700X	Clinical Social Worker	149.021036	IL

General Provider Information

NPI Number	:	1679180194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIM ELLEN MCKINNEY

Provider Business Mailing Address
First Line	:	3938 W 21ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-2810
Country	:	US
Telephone Number	:	312-399-0483
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 WINDSOR DR STE 111&113
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1536
Country	:	US
Telephone Number	:	630-728-1744
Fax Number	:	630-998-7029

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

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	04/17/2026

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