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General NPI Number Information
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NPI Number | 1508547035
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Entity Type | Individual
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Provider Name | KYLIE WONG
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Gender | Female
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 53 W JACKSON BLVD STE 604
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City | CHICAGO
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State | IL
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Zip | 60604-3448
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Country | US
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Telephone | 773-242-4758
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Fax |
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Provider Business Mailing Address
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Address Line | 1918 ORRINGTON AVE
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City | EVANSTON
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State | IL
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Zip | 60201-2910
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Country | US
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Telephone | 224-432-9618
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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