Healthcare Provider Details

I. General information

NPI: 1285516138
Provider Name (Legal Business Name): KENDALL GRACE BERTSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 GRAND AVE STE 1
FRANKLIN PARK IL
60131-2564
US

IV. Provider business mailing address

827 S BROADWAY AVE
PARK RIDGE IL
60068-4337
US

V. Phone/Fax

Practice location:
  • Phone: 847-451-0330
  • Fax:
Mailing address:
  • Phone: 312-835-1667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: