Healthcare Provider Details

I. General information

NPI: 1538544978
Provider Name (Legal Business Name): KIMBERLY MONKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 12/09/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N MICHIGAN AVE
CHICAGO IL
60601-7757
US

IV. Provider business mailing address

972 DOGWOOD LN
COLLEGEVILLE PA
19426-4125
US

V. Phone/Fax

Practice location:
  • Phone: 312-766-6780
  • Fax:
Mailing address:
  • Phone:
  • 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:
Title or Position:
Credential:
Phone: