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Individual

MACKENZIE KELLY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1645 W JACKSON BLVD STE 400, CHICAGO, IL 60612
(312) 942-5932
(312) 942-4990
Mailing address
1645 W JACKSON BLVD STE 400, CHICAGO, IL 60612-3244
(312) 942-5932
(312) 942-4990

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-009818
IL

Other

Enumeration date
05/26/2015
Last updated
12/05/2018
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