Healthcare Provider Details

I. General information

NPI: 1700498003
Provider Name (Legal Business Name): KAYLA PEDRAZA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 LAKE ST STE 400
OAK PARK IL
60301-1413
US

IV. Provider business mailing address

715 LAKE ST STE 400
OAK PARK IL
60301-1413
US

V. Phone/Fax

Practice location:
  • Phone: 773-312-3612
  • Fax:
Mailing address:
  • Phone: 773-312-3612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17016141
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: