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General NPI Number Information
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NPI Number | 1770359291
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Entity Type | Individual
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Provider Name | KAYLA JENSENA HARLAN LSW, P-CADC
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 2845 N SHERIDAN RD SUITE 809
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City | CHICAGO
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State | IL
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Zip | 60657-7227
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Country | US
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Telephone | 312-761-4721
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Fax |
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Provider Business Mailing Address
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Address Line | 3249 W EVERGREEN AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60651-3185
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Country | US
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Telephone | 815-218-5282
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150112873
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License Number State | IL
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