Provider Demographics
NPI:1033340815
Name:SIMON, KATHERINE A
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:SIMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 OAK AVE
Mailing Address - Street 2:APT 3A
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1321 OAK AVE
Practice Address - Street 2:APT 3A
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4240
Practice Address - Country:US
Practice Address - Phone:847-668-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist