Healthcare Provider Details

I. General information

NPI: 1033793021
Provider Name (Legal Business Name): KATE WEIR APRN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W BRADLEY PL STE 100
CHICAGO IL
60618-4716
US

IV. Provider business mailing address

2500 W BRADLEY PL STE 100
CHICAGO IL
60618-4716
US

V. Phone/Fax

Practice location:
  • Phone: 773-739-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIN ALENCIKS
Title or Position: OPS DIRECTOR
Credential:
Phone: 773-266-6681