Provider Demographics
NPI:1366484669
Name:CHRYSALIS, LLC
Entity type:Organization
Organization Name:CHRYSALIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:DOROTHY
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW /LCSW
Authorized Official - Phone:785-840-7088
Mailing Address - Street 1:122 S MICHIGAN AVE STE 1441
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6173
Mailing Address - Country:US
Mailing Address - Phone:785-840-7088
Mailing Address - Fax:
Practice Address - Street 1:122 S MICHIGAN AVE STE 1441
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6173
Practice Address - Country:US
Practice Address - Phone:785-840-7088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS180530Medicare UPIN
KS180530Medicare ID - Type UnspecifiedMEDICARE PART B GRP