Provider Demographics
NPI:1467132993
Name:KIRKLIN, RENE LOUISE
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:LOUISE
Last Name:KIRKLIN
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:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-0661
Mailing Address - Country:US
Mailing Address - Phone:847-946-1861
Mailing Address - Fax:
Practice Address - Street 1:1790 NATIONS DR STE 110
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9175
Practice Address - Country:US
Practice Address - Phone:847-946-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health