Healthcare Provider Details

I. General information

NPI: 1770359291
Provider Name (Legal Business Name): KAYLA JENSENA HARLAN LSW, P-CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 N SHERIDAN RD SUITE 809
CHICAGO IL
60657-7227
US

IV. Provider business mailing address

3249 W EVERGREEN AVE APT 2
CHICAGO IL
60651-3185
US

V. Phone/Fax

Practice location:
  • Phone: 312-761-4721
  • Fax:
Mailing address:
  • Phone: 815-218-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150112873
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: