Healthcare Provider Details

I. General information

NPI: 1518806496
Provider Name (Legal Business Name): CHAD PATRICK KINGSBURY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 HARRISON ST
EVANSTON IL
60201-1204
US

IV. Provider business mailing address

2900 HARRISON ST
EVANSTON IL
60201-1204
US

V. Phone/Fax

Practice location:
  • Phone: 847-238-2220
  • Fax:
Mailing address:
  • Phone: 847-238-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.031613
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: