Healthcare Provider Details

I. General information

NPI: 1891612321
Provider Name (Legal Business Name): KAYLA FITZGIBBONS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 W CHICAGO AVE
CHICAGO IL
60642-5449
US

IV. Provider business mailing address

196 S LINDEN AVE
ELMHURST IL
60126-3670
US

V. Phone/Fax

Practice location:
  • Phone: 847-494-1598
  • Fax:
Mailing address:
  • Phone: 630-640-4294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: