Provider Demographics
NPI:1235455163
Name:KIDS ABOVE ALL ILLINOIS
Entity Type:Organization
Organization Name:KIDS ABOVE ALL ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LAUREANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-284-0430
Mailing Address - Street 1:8765 W HIGGINS RD
Mailing Address - Street 2:SUITE 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 1:1260 IROQUOIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8547
Practice Address - Country:US
Practice Address - Phone:630-778-7542
Practice Address - Fax:630-778-7542
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
IL01203311261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health