Healthcare Provider Details

I. General information

NPI: 1659148245
Provider Name (Legal Business Name): RACHEL KIRKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2036 N HUMBOLDT BLVD
CHICAGO IL
60647-3847
US

IV. Provider business mailing address

2036 N HUMBOLDT BLVD
CHICAGO IL
60647-3847
US

V. Phone/Fax

Practice location:
  • Phone: 415-686-3759
  • Fax:
Mailing address:
  • Phone: 415-686-3759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.017859
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: