Healthcare Provider Details

I. General information

NPI: 1780523118
Provider Name (Legal Business Name): KELLY MCKENNA BOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SHERMER RD
NORTHBROOK IL
60062-4539
US

IV. Provider business mailing address

21 S PATTON AVE
ARLINGTON HEIGHTS IL
60005-1653
US

V. Phone/Fax

Practice location:
  • Phone: 312-725-0655
  • Fax:
Mailing address:
  • Phone: 224-567-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: