Healthcare Provider Details

I. General information

NPI: 1124832167
Provider Name (Legal Business Name): MS. KAVYA KORLAPATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2025
Last Update Date: 02/01/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2259 S DAMEN AVE
CHICAGO IL
60608-4232
US

IV. Provider business mailing address

1504 N DEARBORN PKWY APT 412
CHICAGO IL
60610-1427
US

V. Phone/Fax

Practice location:
  • Phone: 872-281-7575
  • Fax:
Mailing address:
  • Phone: 773-290-7606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178021226
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: