Healthcare Provider Details

I. General information

NPI: 1154232536
Provider Name (Legal Business Name): JADE NICOLE KENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
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: 312-802-4190
  • Fax: 773-902-2647
Mailing address:
  • Phone: 312-802-4190
  • Fax: 773-902-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: