=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093458200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KURT MOHNING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2022
-----------------------------------------------------
Last Update Date | 04/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4633 N WESTERN AVE STE 211
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-2181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-319-4325
-----------------------------------------------------
Fax | 773-439-5683
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4633 N WESTERN AVE STE 211
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-2181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-319-4325
-----------------------------------------------------
Fax | 773-439-5683
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. KURT MATTHEW MOHNING
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 773-319-4325
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------