Healthcare Provider Details

I. General information

NPI: 1962052357
Provider Name (Legal Business Name): KIMBERLY KAPLAN MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REVERE DR STE 100
NORTHBROOK IL
60062-1567
US

IV. Provider business mailing address

510 POPLAR DR
WILMETTE IL
60091-2717
US

V. Phone/Fax

Practice location:
  • Phone: 847-291-6805
  • Fax:
Mailing address:
  • Phone: 847-778-5029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.016251
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: