Healthcare Provider Details

I. General information

NPI: 1760707947
Provider Name (Legal Business Name): KIDS ABOVE ALL ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3753 S COTTAGE GROVE AVE 2ND FLOOR
CHICAGO IL
60653-1407
US

IV. Provider business mailing address

8765 W HIGGINS RD STE # 450
CHICAGO IL
60631-4101
US

V. Phone/Fax

Practice location:
  • Phone: 773-693-0300
  • Fax: 773-693-0322
Mailing address:
  • Phone: 773-693-0300
  • Fax: 773-693-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. JERI LAUREANO
Title or Position: COO
Credential: LCSW
Phone: 773-239-8940