Healthcare Provider Details

I. General information

NPI: 1538094164
Provider Name (Legal Business Name): KJL FOR LIFE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 KENMORE AVE
DEERFIELD IL
60015-4744
US

IV. Provider business mailing address

211 KENMORE AVE
DEERFIELD IL
60015-4744
US

V. Phone/Fax

Practice location:
  • Phone: 847-494-1946
  • Fax:
Mailing address:
  • Phone: 847-494-1946
  • Fax:

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

VIII. Authorized Official

Name: KIMBERLY J LAZARUS
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 847-494-1946