Provider Demographics
NPI:1659132355
Name:GAO, KELSEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 W 14TH PL UNIT 321
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2997
Mailing Address - Country:US
Mailing Address - Phone:224-430-9331
Mailing Address - Fax:
Practice Address - Street 1:4043 N RAVENSWOOD AVE STE 301
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:312-967-4669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.011149103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical