Provider Demographics
NPI:1801534755
Name:KI PSYCHIATRY
Entity type:Organization
Organization Name:KI PSYCHIATRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ISCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:630-201-1533
Mailing Address - Street 1:1990 LARKIN AVE # C3
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5827
Mailing Address - Country:US
Mailing Address - Phone:630-528-0736
Mailing Address - Fax:636-764-5997
Practice Address - Street 1:1990 LARKIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5827
Practice Address - Country:US
Practice Address - Phone:630-201-1533
Practice Address - Fax:636-764-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-21
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1801434733OtherPHYSICIAN SERVICES
IL1801434733OtherCOMMERCIAL INSURANCE
IL1801434733OtherNURSE PRACTITIONER SERVICES
IL1801434733OtherHEALTHY KIDS SERVICES
IL1801434733Medicaid