Healthcare Provider Details

I. General information

NPI: 1487267985
Provider Name (Legal Business Name): KIRA LUCILLE SPEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 GRANDSTAND PL
ELGIN IL
60123-6603
US

IV. Provider business mailing address

1900 RIVERWOOD DR
ALGONQUIN IL
60102-3706
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-0484
  • Fax: 847-697-9307
Mailing address:
  • Phone: 815-355-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: