Healthcare Provider Details

I. General information

NPI: 1851202964
Provider Name (Legal Business Name): AISHA EBONY KINSLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 E 90TH ST
CHICAGO IL
60617-3219
US

IV. Provider business mailing address

3009 E 90TH ST
CHICAGO IL
60617-3219
US

V. Phone/Fax

Practice location:
  • Phone: 773-520-1370
  • Fax:
Mailing address:
  • Phone: 773-371-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: