Healthcare Provider Details

I. General information

NPI: 1609783604
Provider Name (Legal Business Name): KATHLEEN REILLY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15303 S 94TH AVE STE 250
ORLAND PARK IL
60462-3825
US

IV. Provider business mailing address

15303 S 94TH AVE STE 250
ORLAND PARK IL
60462-3825
US

V. Phone/Fax

Practice location:
  • Phone: 708-505-5205
  • Fax:
Mailing address:
  • Phone: 888-428-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.023360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: