Provider Demographics
NPI:1720707821
Name:THOMPSON, KAYLIN MCKELLA (LPC)
Entity Type:Individual
Prefix:
First Name:KAYLIN
Middle Name:MCKELLA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 E LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5515
Mailing Address - Country:US
Mailing Address - Phone:318-609-2631
Mailing Address - Fax:
Practice Address - Street 1:1000 JORIE BLVD STE 36
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4501
Practice Address - Country:US
Practice Address - Phone:630-560-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.018281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional