Provider Demographics
NPI:1033637103
Name:JABLONSKI DAVIDSON, KELSEY LYN (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYN
Last Name:JABLONSKI DAVIDSON
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 MEADOW RD # 200A
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-8300
Mailing Address - Country:US
Mailing Address - Phone:847-345-6270
Mailing Address - Fax:
Practice Address - Street 1:1240 MEADOW RD # 200A
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-8300
Practice Address - Country:US
Practice Address - Phone:847-345-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL34586101YA0400X
IL149.0295501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)