Healthcare Provider Details

I. General information

NPI: 1407087968
Provider Name (Legal Business Name): KIRSTEN SENICA LANGLEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2009
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 W JACKSON BLVD STE 515
CHICAGO IL
60607-3061
US

IV. Provider business mailing address

820 W JACKSON BLVD STE 515
CHICAGO IL
60607-3061
US

V. Phone/Fax

Practice location:
  • Phone: 312-718-3336
  • Fax:
Mailing address:
  • Phone: 312-718-3336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007807
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number071007807
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: