Provider Demographics
NPI:1790660751
Name:MAINOU KINGWERGS, PAULINE
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:MAINOU KINGWERGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:
Other - Last Name:MAINOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3734 N SHEFFIELD AVE APT GS
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3047 N LINCOLN AVE # 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4999
Practice Address - Country:US
Practice Address - Phone:773-494-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.021871101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor