Organization
KB PSYCHOLOGICAL PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLY L BAKER PSYD (PRESIDENT / OWNER)
(708) 925-4523
Entity
Organization
Contact information
Practice address
7010 S UNION AVE, CHICAGO, IL 60621-2418
(708) 925-4523
(855) 727-4855
Mailing address
1824 CAMBRIDGE AVE, FLOSSMOOR, IL 60422-2132
(708) 925-4523
(855) 727-4855
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.00142
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071.008142
PROFESSIONAL LICENSE
IL
Enumeration date
10/13/2015
Last updated
08/25/2016
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