MEDICARE: KEI

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1376978080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEI

Provider Business Mailing Address
First Line	:	4412 N OAK PARK AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4836
Country	:	US
Telephone Number	:	773-793-4846
Fax Number	:	708-395-5158

Provider Business Practice Location Address
First Line	:	4412 N OAK PARK AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4836
Country	:	US
Telephone Number	:	773-793-4846
Fax Number	:	708-395-5158

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. ERICA ESTRADA
Credential	:	AD
Telephone Number	:	773-793-4846

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	09/12/2013

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Directions to “KEI ” Practice Location

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