Provider Demographics
NPI:1811462807
Name:ROXAS, JIN KYLIE
Entity type:Individual
Prefix:
First Name:JIN KYLIE
Middle Name:
Last Name:ROXAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 N BELL AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2094
Mailing Address - Country:US
Mailing Address - Phone:312-478-8683
Mailing Address - Fax:
Practice Address - Street 1:6307 N BELL AVE APT 2S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2094
Practice Address - Country:US
Practice Address - Phone:312-478-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional