Healthcare Provider Details

I. General information

NPI: 1538046719
Provider Name (Legal Business Name): WOVEN PSYCHOTHERAPY CHICAGO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 N WESTERN AVE APT 4
CHICAGO IL
60625-7950
US

IV. Provider business mailing address

4505 N WESTERN AVE APT 4
CHICAGO IL
60625-7950
US

V. Phone/Fax

Practice location:
  • Phone: 815-701-1393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KAYLA HARTMAN
Title or Position: THERAPIST
Credential: LCSW
Phone: 815-701-1393