Provider Demographics
NPI:1003432345
Name:BACH, KATHRYN P (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:P
Last Name:BACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 CAVALIER CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-3106
Mailing Address - Country:US
Mailing Address - Phone:630-561-6070
Mailing Address - Fax:
Practice Address - Street 1:1608 CAVALIER CT
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-3106
Practice Address - Country:US
Practice Address - Phone:630-561-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490221791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical