Provider Demographics
NPI:1053478560
Name:POWELL, KATHLEEN SUE (MSW LCSW ACSW BCD CI)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SUE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MSW LCSW ACSW BCD CI
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:SUE
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:1717 N NAPER BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8802
Mailing Address - Country:US
Mailing Address - Phone:630-369-2494
Mailing Address - Fax:630-245-0337
Practice Address - Street 1:1717 N NAPER BLVD
Practice Address - Street 2:STE 200
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8802
Practice Address - Country:US
Practice Address - Phone:630-369-2494
Practice Address - Fax:630-245-0337
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490015131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149001513OtherLCSW
Q28566Medicare UPIN
210352Medicare ID - Type Unspecified