Provider Demographics
NPI:1093839987
Name:CHILAMKURTI, CHINNI (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHINNI
Middle Name:
Last Name:CHILAMKURTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S ATKINSON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7817
Mailing Address - Country:US
Mailing Address - Phone:847-548-0024
Mailing Address - Fax:
Practice Address - Street 1:100 S ATKINSON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7817
Practice Address - Country:US
Practice Address - Phone:847-548-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent