Provider Demographics
NPI:1598246779
Name:ENOCH, KIRSTEN (LCSW)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:ENOCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:RIECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4327 W IRVING PARK RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2826
Mailing Address - Country:US
Mailing Address - Phone:224-458-5027
Mailing Address - Fax:
Practice Address - Street 1:4327 W IRVING PARK RD STE 2A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2826
Practice Address - Country:US
Practice Address - Phone:224-458-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0230871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical