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NPI Code Detail

MEDICARE: HEATHER RUTH KINSLEY LPC

MEDICARE: HEATHER RUTH KINSLEY LPC
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
1101YM0800XMental Health Counselor178.016873IL

General Provider Information

NPI Number : 1679153118
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER RUTH KINSLEY LPC
Provider Business Mailing Address
First Line : 2108 SHERMAN AVE APT 1W
Second Line :
City : EVANSTON
State : IL
Zip : 60201-3223
Country : US
Telephone Number : 847-624-3699
Fax Number :
Provider Business Practice Location Address
First Line : 30 N MICHIGAN AVE STE 1920
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3618
Country : US
Telephone Number : 312-980-6410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2021
Last Update Date : 04/09/2021

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Directions to “ HEATHER RUTH KINSLEY LPC” Practice Location

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