MEDICARE: KYRA LEE KEUBEN LCSW

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	1041C0700X	Clinical Social Worker	149.022552	IL

General Provider Information

NPI Number	:	1801480629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYRA LEE KEUBEN LCSW

Provider Business Mailing Address
First Line	:	3452 N AVERS AVE APT 3R
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5214
Country	:	US
Telephone Number	:	630-740-7074
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 N MILWAUKEE AVE STE 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2156
Country	:	US
Telephone Number	:	773-234-2898
Fax Number	:

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

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	12/10/2023

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