KB Psychological Practice, PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.00142 Issued in IL

Legal business name

KB PSYCHOLOGICAL PRACTICE, PC

Practice address

7010 S Union Ave
Chicago, IL 60621-2418

Phone

(708) 925-4523

Fax

(855) 727-4855

NPI assigned

Oct 13, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kimberly L Baker, PSYD

Title

President / Owner

Phone

(708) 925-4523

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472083200000",
    "number": "1063883395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1824 CAMBRIDGE AVE",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604222132",
            "telephone_number": "708-925-4523",
            "fax_number": "855-727-4855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7010 S UNION AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606212418",
            "telephone_number": "708-925-4523",
            "fax_number": "855-727-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KB PSYCHOLOGICAL PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-13",
        "last_updated": "2016-08-25",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT / OWNER",
        "authorized_official_telephone_number": "708-925-4523",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.00142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "071.008142",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly A Kazukauskas, PHD, LCPC, CRC, CVE
• Kristin Kazyaka, PH.D.
• Shira Kazzaz, NP
• KB & Associates LLC
• KB Enterprises of Chicago LLC
• KBC Consulting, PLLC
• Beylul Kbreab
• KC Care Inc
• KC Care Inc
• KC Management Group

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.