Provider Demographics
NPI:1649796186
Name:CHERPES, KYLIE MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KYLIE
Middle Name:MARIE
Last Name:CHERPES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 N MILWAUKEE AVE # B167
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6905
Mailing Address - Country:US
Mailing Address - Phone:989-640-7706
Mailing Address - Fax:
Practice Address - Street 1:1658 N MILWAUKEE AVE # B167
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6905
Practice Address - Country:US
Practice Address - Phone:989-640-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI575228106H00000X
IL149.0216261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist