Provider Demographics
NPI:1548051436
Name:KISH, GIAVANNA LOUISE
Entity type:Individual
Prefix:
First Name:GIAVANNA
Middle Name:LOUISE
Last Name:KISH
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 1:1951 N MONTICELLO AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3624
Mailing Address - Country:US
Mailing Address - Phone:630-669-1178
Mailing Address - Fax:
Practice Address - Street 1:1951 N MONTICELLO AVE # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3624
Practice Address - Country:US
Practice Address - Phone:630-669-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178021623101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor