Healthcare Provider Details

I. General information

NPI: 1659218592
Provider Name (Legal Business Name): KEJAL B PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LAKEVIEW PKWY STE 180
VERNON HILLS IL
60061-1850
US

IV. Provider business mailing address

6066 CANTERBURY LN
HOFFMAN ESTATES IL
60192-4802
US

V. Phone/Fax

Practice location:
  • Phone: 847-996-6666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178023090
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: