Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Life Made Krystal Clear LLC

Organization Clinical Social Worker · NPI 1629817523

Life Made Krystal Clear LLC is a Clinical Social Worker in Chicago, Illinois. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2045 W Grand Ave Ste B
Chicago, IL 60612-1577
Phone: (312) 933-3167
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X

Record details

NPI number1629817523
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Krystal Fowlkes — Child & Family Therapist · (312) 933-3167
NPI enumeratedMay 21, 2024
Last updated in NPPESMay 21, 2024
Certification dateMay 21, 2024
Mailing address2045 W Grand Ave Ste B, Chicago, IL 60612-1577

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