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General NPI Number Information
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NPI Number | 1801480629
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Entity Type | Individual
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Provider Name | KYRA LEE KEUBEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/22/2021
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Last Update Date | 12/10/2023
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Provider Practice Location Address
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Address Line | 4800 N MILWAUKEE AVE STE 202
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City | CHICAGO
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State | IL
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Zip | 60630-2156
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Country | US
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Telephone | 773-234-2898
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Fax |
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Provider Business Mailing Address
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Address Line | 3452 N AVERS AVE APT 3R
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City | CHICAGO
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State | IL
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Zip | 60618-5214
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Country | US
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Telephone | 630-740-7074
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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 | 149.022552
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License Number State | IL
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