=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053102533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIERNAN WRIGHT, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2025
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 W INSTITUTE PLACE CHICAGO, IL SUITE 500
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-335-7558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8603 LINDER AVE
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60459-2927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-778-2139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | KIERNAN WRIGHT
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 330-778-2139
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------