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General NPI Number Information
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NPI Number | 1912861782
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Entity Type | Individual
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Provider Name | KENDRA CALLISON
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Gender | Female
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 848 W EASTMAN ST STE 103
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City | CHICAGO
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State | IL
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Zip | 60642-2635
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Country | US
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Telephone | 312-702-2303
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Fax |
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Provider Business Mailing Address
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Address Line | 515 W BRIAR PL APT 503
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City | CHICAGO
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State | IL
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Zip | 60657-4627
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | IL
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