Healthcare Provider Details

I. General information

NPI: 1124919394
Provider Name (Legal Business Name): KS WELLNESS GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 N PINE GROVE AVE APT 6H
CHICAGO IL
60614-6513
US

IV. Provider business mailing address

10277 W LINCOLN HWY
FRANKFORT IL
60423-1279
US

V. Phone/Fax

Practice location:
  • Phone: 224-307-6588
  • Fax:
Mailing address:
  • Phone: 608-354-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KAITLIN SKOG
Title or Position: OWNER
Credential: LCPC
Phone: 608-354-6961