Provider Demographics
NPI:1134489578
Name:BJERKE, KATHRYN E (LMT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:BJERKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11248 WALTON DR
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-8122
Mailing Address - Country:US
Mailing Address - Phone:815-623-1569
Mailing Address - Fax:
Practice Address - Street 1:11248 WALTON DR
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-8122
Practice Address - Country:US
Practice Address - Phone:815-623-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227013165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist