1396890364 NPI number — MS. KATHLEEN M WOODS MSW, LCSW

Table of content: MS. KATHLEEN M WOODS MSW, LCSW (NPI 1396890364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396890364 NPI number — MS. KATHLEEN M WOODS MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS
Provider First Name:
KATHLEEN
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396890364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT PROSPECT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60056-0071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-797-0310
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 W EASTMAN ST
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
ARLINGTON HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60004-5937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-797-0310
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007

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 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 016-05278 . This is a "BLUE CROSS BLUE SHEILD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com