Provider Demographics
NPI:1174370282
Name:ROSENKRANZ, KIMBEAU ELLEN
Entity type:Individual
Prefix:
First Name:KIMBEAU
Middle Name:ELLEN
Last Name:ROSENKRANZ
Suffix:
Gender:X
Credentials:
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ELLEN
Other - Last Name:ROSENKRANZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BFA
Mailing Address - Street 1:4423 N RAVENSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4423 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5802
Practice Address - Country:US
Practice Address - Phone:773-572-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist