Provider Demographics
NPI:1871938753
Name:KIMBERLY A. KICK, LCSW & ASSOCIATES, LTD.
Entity type:Organization
Organization Name:KIMBERLY A. KICK, LCSW & ASSOCIATES, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,MSW, LCSW
Authorized Official - Phone:847-400-6204
Mailing Address - Street 1:709 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1913
Mailing Address - Country:US
Mailing Address - Phone:847-400-6204
Mailing Address - Fax:847-327-1592
Practice Address - Street 1:709 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1913
Practice Address - Country:US
Practice Address - Phone:847-400-6204
Practice Address - Fax:847-327-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-005107251S00000X
IL060011046251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1548OtherPTAN