Healthcare Provider Details

I. General information

NPI: 1215793948
Provider Name (Legal Business Name): HANNAH KIM WYKOSKI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 N HIGHLAND AVE STE 202
AURORA IL
60506-1460
US

IV. Provider business mailing address

1233 W ADAMS ST
CHICAGO IL
60607-2801
US

V. Phone/Fax

Practice location:
  • Phone: 616-706-9032
  • Fax:
Mailing address:
  • Phone: 312-243-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150106957
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: