Healthcare Provider Details

I. General information

NPI: 1891232328
Provider Name (Legal Business Name): KYLA KACHMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 DAVIS ST STE 160
EVANSTON IL
60201-3664
US

IV. Provider business mailing address

909 DAVIS ST STE 160
EVANSTON IL
60201-3664
US

V. Phone/Fax

Practice location:
  • Phone: 847-425-6400
  • Fax: 847-425-6408
Mailing address:
  • Phone: 847-425-6400
  • Fax: 847-425-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149018359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: