Healthcare Provider Details

I. General information

NPI: 1356229504
Provider Name (Legal Business Name): PATRICK LOGISTICS CONSULTANCY & TRAINING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W 63RD ST FL 4
CHICAGO IL
60621-1917
US

IV. Provider business mailing address

6636 S YALE AVE
CHICAGO IL
60621-3836
US

V. Phone/Fax

Practice location:
  • Phone: 866-213-1912
  • Fax:
Mailing address:
  • Phone: 773-619-7247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENYATTA VAUGHN
Title or Position: CEO
Credential:
Phone: 773-619-7247