Provider Demographics
NPI:1114568219
Name:KATES, JONAE
Entity Type:Individual
Prefix:
First Name:JONAE
Middle Name:
Last Name:KATES
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 1:4421 LINDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1840
Mailing Address - Country:US
Mailing Address - Phone:773-369-5501
Mailing Address - Fax:
Practice Address - Street 1:4421 LINDENWOOD DR
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-1840
Practice Address - Country:US
Practice Address - Phone:773-369-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist