1447293097 NPI number — MS. KATHRYN L WEEKS LCSW

Table of content: MS. KATHRYN L WEEKS LCSW (NPI 1447293097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447293097 NPI number — MS. KATHRYN L WEEKS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEEKS
Provider First Name:
KATHRYN
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOFOED-ACKERMAN-HUBBARD
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447293097
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15908 N GORHAM LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WADSWORTH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60083-9414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-395-6988
Provider Business Mailing Address Fax Number:
847-395-6989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4103 60TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53144-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-652-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  536-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 030452095018 . This is a "BCBS-BILLING PROVIDER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 42233900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7069698 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 40968900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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