Provider Demographics
NPI:1508234998
Name:O'CONNELL, KYLIE (BSW)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6918 W WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3334
Mailing Address - Country:US
Mailing Address - Phone:708-795-4834
Mailing Address - Fax:
Practice Address - Street 1:6918 W WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3334
Practice Address - Country:US
Practice Address - Phone:708-795-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker