Healthcare Provider Details

I. General information

NPI: 1922704717
Provider Name (Legal Business Name): KAITLIN SKOG LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 RIDGE AVE SUITE 007
EVANSTON IL
60201
US

IV. Provider business mailing address

2740 N PINE GROVE AVE APT 6H
CHICAGO IL
60614-6513
US

V. Phone/Fax

Practice location:
  • Phone: 224-307-6588
  • Fax:
Mailing address:
  • Phone: 608-354-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.014902
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: