Healthcare Provider Details

I. General information

NPI: 1902358930
Provider Name (Legal Business Name): KENNETH YOUNG CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 E HINTZ RD
ARLINGTON HEIGHTS IL
60004-2268
US

IV. Provider business mailing address

1001 ROHLWING RD
ELK GROVE VILLAGE IL
60007-3217
US

V. Phone/Fax

Practice location:
  • Phone: 847-524-8800
  • Fax: 847-524-8824
Mailing address:
  • Phone: 847-524-8800
  • Fax: 847-524-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. SUSAN COWEN
Title or Position: CHIEF EXECUTIVE OFFICIER
Credential: LCSW
Phone: 847-524-8800