Healthcare Provider Details

I. General information

NPI: 1801181045
Provider Name (Legal Business Name): DAVID KLOW & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2436 COWPER AVE
EVANSTON IL
60201-1846
US

IV. Provider business mailing address

2436 COWPER AVE
EVANSTON IL
60201-1846
US

V. Phone/Fax

Practice location:
  • Phone: 847-529-8300
  • Fax:
Mailing address:
  • Phone: 847-529-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166000754
License Number StateIL

VIII. Authorized Official

Name: DAVID I KLOW
Title or Position: OWNER
Credential: LMFT
Phone: 847-529-8300