Provider Demographics
NPI:1023736527
Name:KIM, JANE Y (LSW)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:Y
Last Name:KIM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6442 N BOSWORTH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-6668
Mailing Address - Country:US
Mailing Address - Phone:224-730-9892
Mailing Address - Fax:
Practice Address - Street 1:405 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3006
Practice Address - Country:US
Practice Address - Phone:847-441-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2024-07-19
Deactivation Date:2024-05-16
Deactivation Code:
Reactivation Date:2024-07-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health