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General NPI Number Information
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NPI Number | 1417556283
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Entity Type | Organization
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Legal Business Name | KJP ALLIANCE LLC
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 16595 W EASTON AVE STE 1
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-2744
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Country | US
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Telephone | 847-242-1669
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Fax | 847-242-1669
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Provider Business Mailing Address
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Address Line | 136 PARK DR
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City | PORT BARRINGTON
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State | IL
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Zip | 60010-1031
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Country | US
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Telephone | 773-350-6560
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Fax | 847-242-1669
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Authorized Official
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Title or Position | DIRECTOR
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Name | DAVID SCHAEFER
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Credential | LCPC
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Telephone | 773-350-6560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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