Healthcare Provider Details

I. General information

NPI: 1003391749
Provider Name (Legal Business Name): KIDS ABOVE ALL ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNITED METHODIST CHURCH 651 LILLIE STREET
ELGIN IL
60120
US

IV. Provider business mailing address

8765 W HIGGINS RD STE 450
CHICAGO IL
60631-2794
US

V. Phone/Fax

Practice location:
  • Phone: 630-883-8560
  • Fax: 630-883-8641
Mailing address:
  • Phone: 773-693-0300
  • Fax: 773-693-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

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