Healthcare Provider Details

I. General information

NPI: 1710859970
Provider Name (Legal Business Name): KENDALL HINSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 N CLARK ST STE 206
CHICAGO IL
60614-1850
US

IV. Provider business mailing address

922 W WASHINGTON BLVD APT 401
CHICAGO IL
60607-2250
US

V. Phone/Fax

Practice location:
  • Phone: 773-850-0294
  • Fax:
Mailing address:
  • Phone: 843-368-9326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number071.022339
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number071.022339
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number071.022339
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number071.022339
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: