Provider Demographics
NPI:1790571446
Name:BOYD, KATISHA (LSW)
Entity type:Individual
Prefix:
First Name:KATISHA
Middle Name:
Last Name:BOYD
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4238 W GRENSHAW ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-3931
Mailing Address - Country:US
Mailing Address - Phone:773-997-5091
Mailing Address - Fax:
Practice Address - Street 1:901 N ELM ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3632
Practice Address - Country:US
Practice Address - Phone:630-556-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.110305101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor