MEDICARE: MIKA KERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1023785243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKA KERN

Provider Business Mailing Address
First Line	:	6024 N SAINT LOUIS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3304
Country	:	US
Telephone Number	:	708-305-4609
Fax Number	:

Provider Business Practice Location Address
First Line	:	6024 N SAINT LOUIS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3304
Country	:	US
Telephone Number	:	708-305-4609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2021
Last Update Date	:	08/25/2021

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Directions to “ MIKA KERN ” Practice Location

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