Provider Demographics
NPI:1447464599
Name:MILL, KORI C (MA, LCSW)
Entity type:Individual
Prefix:MS
First Name:KORI
Middle Name:C
Last Name:MILL
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W PRATT BLVD
Mailing Address - Street 2:#2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4413
Mailing Address - Country:US
Mailing Address - Phone:773-338-7164
Mailing Address - Fax:
Practice Address - Street 1:2526 N LINCOLN AVE
Practice Address - Street 2:#218
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2353
Practice Address - Country:US
Practice Address - Phone:773-869-6092
Practice Address - Fax:773-869-2371
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001634097OtherBLUE CROSS BLUE SHIELD