Provider Demographics
NPI:1023983608
Name:GREEN, KYLEE ELIZABETH
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:ELIZABETH
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 S BLAKELY DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2779
Mailing Address - Country:US
Mailing Address - Phone:630-947-4518
Mailing Address - Fax:
Practice Address - Street 1:220 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-3500
Practice Address - Country:US
Practice Address - Phone:630-601-8625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL23-280403106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician