1891034542 NPI number — MS. KARI LG KIMPTON LCSW

Table of content: MS. KARI LG KIMPTON LCSW (NPI 1891034542)

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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