1831323989 NPI number — MRS. KATHRYN MARIE VAN HOUTEN

Table of content: MRS. KATHRYN MARIE VAN HOUTEN (NPI 1831323989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831323989 NPI number — MRS. KATHRYN MARIE VAN HOUTEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN HOUTEN
Provider First Name:
KATHRYN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PENCE
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831323989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 GAMBLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LISLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60532-2369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-702-3850
Provider Business Mailing Address Fax Number:
844-840-7347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 GAMBLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LISLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60532-2369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-702-3850
Provider Business Practice Location Address Fax Number:
844-840-7347
Provider Enumeration Date:
05/05/2009

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: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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