Healthcare Provider Details

I. General information

NPI: 1811808702
Provider Name (Legal Business Name): LAUREN KELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N OAK PARK AVE
CHICAGO IL
60707-3351
US

IV. Provider business mailing address

2211 N OAK PARK AVE
CHICAGO IL
60707-3351
US

V. Phone/Fax

Practice location:
  • Phone: 773-466-6922
  • Fax: 813-518-7659
Mailing address:
  • Phone: 773-466-6922
  • Fax: 813-518-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number211000358
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number213000406
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: