1891034542 NPI number — MS. KARI LG KIMPTON LCSW

Table of content: SHAWNA O'DONLEY PA-C (NPI 1326097395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891034542 NPI number — MS. KARI LG KIMPTON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIMPTON
Provider First Name:
KARI
Provider Middle Name:
LG
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GALLAGHER
Provider Other First Name:
KARI
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891034542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 E WOODFIELD ROAD
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
SCHAUMBURG
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60173-5113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-240-2211
Provider Business Mailing Address Fax Number:
847-240-2418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 W HAWTHORN PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
VERNON HILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60061-1447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-932-0808
Provider Business Practice Location Address Fax Number:
847-918-8215
Provider Enumeration Date:
01/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149-011033 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1633897 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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