Provider Demographics
NPI:1104212273
Name:HOOPER, KIJUANA
Entity Type:Individual
Prefix:
First Name:KIJUANA
Middle Name:
Last Name:HOOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8644 S 86TH AVE
Mailing Address - Street 2:BUILDING 10 APT. 113
Mailing Address - City:JUSTICE
Mailing Address - State:IL
Mailing Address - Zip Code:60458-2111
Mailing Address - Country:US
Mailing Address - Phone:708-546-0806
Mailing Address - Fax:708-546-0888
Practice Address - Street 1:8644 S 86TH AVE
Practice Address - Street 2:BUILDING 10 APT. 113
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60458-2111
Practice Address - Country:US
Practice Address - Phone:708-546-0806
Practice Address - Fax:708-546-0888
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health