Provider Demographics
NPI:1205726452
Name:KIRKWOOD, ELEXIS
Entity type:Individual
Prefix:
First Name:ELEXIS
Middle Name:
Last Name:KIRKWOOD
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 1:16125 HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-5939
Mailing Address - Country:US
Mailing Address - Phone:708-297-0803
Mailing Address - Fax:
Practice Address - Street 1:16125 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-5939
Practice Address - Country:US
Practice Address - Phone:708-297-0803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist