Healthcare Provider Details

I. General information

NPI: 1235046608
Provider Name (Legal Business Name): KENNETH BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 S MICHIGAN AVE
CHICAGO IL
60603-3357
US

IV. Provider business mailing address

1860 ASBURY CIRCLE DR APT 214C
JOLIET IL
60435-3611
US

V. Phone/Fax

Practice location:
  • Phone: 312-346-6230
  • Fax:
Mailing address:
  • Phone: 312-866-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150117450
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: