Healthcare Provider Details

I. General information

NPI: 1134479934
Provider Name (Legal Business Name): KIDS ABOVE ALL ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4936 HIGHLAND AVE
DOWNERS GROVE IL
60515-3628
US

IV. Provider business mailing address

8765 W HIGGINS RD SUITE 450
CHICAGO IL
60631-4101
US

V. Phone/Fax

Practice location:
  • Phone: 773-693-0300
  • Fax:
Mailing address:
  • Phone:
  • 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
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JERI LYNN LAUREANO
Title or Position: COO
Credential: LCSW
Phone: 847-284-0430