Healthcare Provider Details

I. General information

NPI: 1831810381
Provider Name (Legal Business Name): KAIELLE SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 E 47TH ST STE 400C
CHICAGO IL
60653-3818
US

IV. Provider business mailing address

539 E 151ST ST
PHOENIX IL
60426-2412
US

V. Phone/Fax

Practice location:
  • Phone: 312-577-7258
  • Fax:
Mailing address:
  • Phone: 630-670-7321
  • 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: