Provider Demographics
NPI:1619609096
Name:LEMAIRE, KELLY LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:LEMAIRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 W WARNER AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1862
Mailing Address - Country:US
Mailing Address - Phone:574-514-2347
Mailing Address - Fax:
Practice Address - Street 1:4043 N RAVENSWOOD AVE STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5683
Practice Address - Country:US
Practice Address - Phone:630-277-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN200043270103TH0100X
NC5412103TH0100X
IL071010781103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service