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General NPI Number Information
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NPI Number | 1427289990
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Entity Type | Individual
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Provider Name | KENDRA RILEY L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 08/01/2009
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 2720 W 15TH ST 3RD FLOOR
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City | CHICAGO
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State | IL
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Zip | 60608-1610
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Country | US
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Telephone | 773-257-2451
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 W MADISON ST
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City | CHICAGO
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State | IL
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Zip | 60624-2334
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Country | US
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Telephone | 773-826-6600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 34005784A
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License Number State | IN
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