Provider Demographics
NPI:1730528282
Name:BERRY, KALEIGH
Entity type:Individual
Prefix:
First Name:KALEIGH
Middle Name:
Last Name:BERRY
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 1:35372 E 1000 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60921-8144
Mailing Address - Country:US
Mailing Address - Phone:815-383-8868
Mailing Address - Fax:
Practice Address - Street 1:310 E TORRANCE AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-2748
Practice Address - Country:US
Practice Address - Phone:815-844-6109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.019491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical