Healthcare Provider Details

I. General information

NPI: 1124923255
Provider Name (Legal Business Name): KENNETH CLOSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NATIONS DR STE 211
GURNEE IL
60031-9173
US

IV. Provider business mailing address

1800 NATIONS DR STE 211
GURNEE IL
60031-9173
US

V. Phone/Fax

Practice location:
  • Phone: 224-222-1510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: