Provider Demographics
NPI:1144883943
Name:CARTER, KENIKA LIONTA
Entity type:Individual
Prefix:
First Name:KENIKA
Middle Name:LIONTA
Last Name:CARTER
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 1:13246 S PRAIRE AV
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60827-1246
Mailing Address - Country:US
Mailing Address - Phone:773-982-4334
Mailing Address - Fax:
Practice Address - Street 1:13246 S PRAIRE AV
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60827-1246
Practice Address - Country:US
Practice Address - Phone:773-982-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist