Healthcare Provider Details

I. General information

NPI: 1598689408
Provider Name (Legal Business Name): KETURAH PLATT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N WELLS ST STE 400
CHICAGO IL
60610-7632
US

IV. Provider business mailing address

1111 N WELLS ST STE 400
CHICAGO IL
60610-7632
US

V. Phone/Fax

Practice location:
  • Phone: 773-572-9578
  • Fax:
Mailing address:
  • Phone: 773-572-9578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: