Provider Demographics
NPI:1922704717
Name:SKOG, KAITLIN (LCPC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:SKOG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 N PINE GROVE AVE APT 6H
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6513
Mailing Address - Country:US
Mailing Address - Phone:608-354-6961
Mailing Address - Fax:
Practice Address - Street 1:518 DAVIS ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4644
Practice Address - Country:US
Practice Address - Phone:224-307-6588
Practice Address - Fax:224-999-1272
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health