Healthcare Provider Details

I. General information

NPI: 1851951974
Provider Name (Legal Business Name): KIDS FIRST COLLABORATIVE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S NAPERVILLE RD STE 203
WHEATON IL
60187-5462
US

IV. Provider business mailing address

319 S NAPERVILLE RD STE 203
WHEATON IL
60187-5462
US

V. Phone/Fax

Practice location:
  • Phone: 630-534-3179
  • Fax: 630-534-2164
Mailing address:
  • Phone: 630-534-3179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY MELTON LECHNER
Title or Position: CLINICAL COUNSELOR, SCHOOL PSYCH
Credential: PH.D.
Phone: 630-534-3179