Provider Demographics
NPI:1023206182
Name:O'CONNOR, KATHLEEN MARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:O'CONNOR
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 1:120 OAKBROOK CTR
Mailing Address - Street 2:SUITE 428
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1806
Mailing Address - Country:US
Mailing Address - Phone:630-928-1173
Mailing Address - Fax:
Practice Address - Street 1:120 OAKBROOK CTR
Practice Address - Street 2:SUITE 428
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1806
Practice Address - Country:US
Practice Address - Phone:708-785-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-006962104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker