Healthcare Provider Details

I. General information

NPI: 1184530719
Provider Name (Legal Business Name): KIRA CRUICKSHANK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 N AVONDALE AVE STE 201
CHICAGO IL
60631-1567
US

IV. Provider business mailing address

604 CAMPBELL ST
JOLIET IL
60435-7030
US

V. Phone/Fax

Practice location:
  • Phone: 773-796-7035
  • Fax:
Mailing address:
  • Phone: 815-258-0269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.022715
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: