Healthcare Provider Details

I. General information

NPI: 1962328138
Provider Name (Legal Business Name): CHIRON WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10851 S ST LOUIS AVENUE
CHICAGO IL
60655
US

IV. Provider business mailing address

10851 S SAINT LOUIS AVE
CHICAGO IL
60655-2615
US

V. Phone/Fax

Practice location:
  • Phone: 773-343-7454
  • Fax:
Mailing address:
  • Phone: 773-343-7454
  • Fax: 773-343-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JENNIFER A. KELLY
Title or Position: OWNER
Credential: LCSW
Phone: 773-343-7454