Provider Demographics
NPI:1922991660
Name:KIM, PHILIP JEESUP (LCSW)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JEESUP
Last Name:KIM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W CLARK ST APT 307
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-4636
Mailing Address - Country:US
Mailing Address - Phone:847-287-8334
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 380
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7710
Practice Address - Country:US
Practice Address - Phone:708-628-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490294251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical