Healthcare Provider Details

I. General information

NPI: 1295253771
Provider Name (Legal Business Name): KAYLEEN KUHN MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLEEN PEN MA, LCPC

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 03/02/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SKOKIE BLVD STE 103&215
NORTHBROOK IL
60062-4013
US

IV. Provider business mailing address

741 W WELLINGTON AVE APT 1
CHICAGO IL
60657-5258
US

V. Phone/Fax

Practice location:
  • Phone: 847-480-0300
  • Fax: 847-291-0576
Mailing address:
  • Phone: 949-910-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.013234
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180013000
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: