Provider Demographics
NPI:1063694727
Name:FORGIE, KIMBERLY C (LCPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:C
Last Name:FORGIE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-3201
Mailing Address - Country:US
Mailing Address - Phone:630-837-9000
Mailing Address - Fax:630-736-2750
Practice Address - Street 1:1400 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-3201
Practice Address - Country:US
Practice Address - Phone:630-837-9000
Practice Address - Fax:630-736-2750
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional