Healthcare Provider Details

I. General information

NPI: 1053730770
Provider Name (Legal Business Name): KAILLIE ENSER WARK MS, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAILLIE MARIE ENSER

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-2923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.004721
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: