Healthcare Provider Details

I. General information

NPI: 1538634266
Provider Name (Legal Business Name): IKIGAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4208 N CENTRAL PARK AVE
CHICAGO IL
60618-2020
US

IV. Provider business mailing address

4208 N CENTRAL PARK AVE
CHICAGO IL
60618-2020
US

V. Phone/Fax

Practice location:
  • Phone: 773-497-2001
  • Fax: 312-253-1413
Mailing address:
  • Phone: 773-497-2001
  • Fax: 312-253-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY HEAP
Title or Position: PRESIDENT
Credential: LCSW
Phone: 224-372-0019