Healthcare Provider Details

I. General information

NPI: 1801507306
Provider Name (Legal Business Name): RUTH KAHSSAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 W MADISON ST STE 209
CHICAGO IL
60624-0315
US

IV. Provider business mailing address

4305 W MADISON ST STE 209
CHICAGO IL
60624-0315
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-9063
  • Fax:
Mailing address:
  • Phone: 312-942-9063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149041192
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: