Provider Demographics
NPI:1477180537
Name:HALILI, KIMVERLI ASHLY ADAMOS
Entity Type:Individual
Prefix:
First Name:KIMVERLI ASHLY
Middle Name:ADAMOS
Last Name:HALILI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMVERLI
Other - Middle Name:A
Other - Last Name:HALILI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1760 W ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-4791
Mailing Address - Country:US
Mailing Address - Phone:847-358-5510
Mailing Address - Fax:
Practice Address - Street 1:1760 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-4791
Practice Address - Country:US
Practice Address - Phone:847-358-5510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician