Healthcare Provider Details

I. General information

NPI: 1841009586
Provider Name (Legal Business Name): ELIZABETH NEAYLON KINNICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 DUNDEE RD STE 101
NORTHBROOK IL
60062-2462
US

IV. Provider business mailing address

250 GRAEMERE ST
NORTHFIELD IL
60093-3133
US

V. Phone/Fax

Practice location:
  • Phone: 847-919-9096
  • Fax:
Mailing address:
  • Phone: 773-844-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: