Provider Demographics
NPI:1154647089
Name:KIDS ABOVE ALL ILLINOIS
Entity Type:Organization
Organization Name:KIDS ABOVE ALL ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LAUREANO
Authorized Official - Suffix:
Authorized Official - Credentials:COO, LCSW
Authorized Official - Phone:847-284-0430
Mailing Address - Street 1:8765 W HIGGINS RD
Mailing Address - Street 2:STE# 450
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-4101
Mailing Address - Country:US
Mailing Address - Phone:773-693-0300
Mailing Address - Fax:773-693-0322
Practice Address - Street 1:2808 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7833
Practice Address - Country:US
Practice Address - Phone:773-867-7319
Practice Address - Fax:773-626-3495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
IL012033-11261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health