Provider Demographics
NPI:1235420845
Name:HIRSCH, KATHERINE
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:HIRSCH
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 1:1111 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3709
Mailing Address - Country:US
Mailing Address - Phone:630-301-0554
Mailing Address - Fax:
Practice Address - Street 1:1111 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3709
Practice Address - Country:US
Practice Address - Phone:630-301-0554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0111331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical