Provider Demographics
NPI:1083125108
Name:VASQUEZ, KATHRYN MARY (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARY
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:MARY
Other - Last Name:PADGITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:10 W PHILLIP RD STE 108
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1730
Mailing Address - Country:US
Mailing Address - Phone:847-275-4115
Mailing Address - Fax:847-868-9222
Practice Address - Street 1:10 W PHILLIP RD STE 108
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1730
Practice Address - Country:US
Practice Address - Phone:847-275-4115
Practice Address - Fax:847-868-9222
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
IL150.014862104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist