Provider Demographics
NPI:1659172286
Name:WARNER, KENYA MONICA (CADC29177)
Entity type:Individual
Prefix:
First Name:KENYA
Middle Name:MONICA
Last Name:WARNER
Suffix:
Gender:
Credentials:CADC29177
Other - Prefix:
Other - First Name:K.
Other - Middle Name:MONICA
Other - Last Name:WARNER MUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1747 E 87TH ST
Mailing Address - Street 2:SUITE B/2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617
Mailing Address - Country:US
Mailing Address - Phone:312-860-2525
Mailing Address - Fax:
Practice Address - Street 1:1747 E 87TH
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:312-860-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL29177101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)