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General NPI Number Information
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NPI Number | 1083588636
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Entity Type | Organization
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Legal Business Name | KINZIE THERAPY & CONSULTING PLLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 2530 CRAWFORD AVE STE 317
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City | EVANSTON
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State | IL
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Zip | 60201-4972
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Country | US
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Telephone | 847-644-0940
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Fax |
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Provider Business Mailing Address
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Address Line | 3611 HILLSIDE RD
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City | EVANSTON
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State | IL
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Zip | 60201-4936
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Country | US
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Telephone | 847-644-0940
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. TAYA KINZIE
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Credential | LCSW, EDD
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Telephone | 847-644-0940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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