Provider Demographics
NPI:1275667289
Name:LIPKIN, KATHRYN BURKHARDT (LCPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:BURKHARDT
Last Name:LIPKIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 MACGREGOR RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-2219
Mailing Address - Country:US
Mailing Address - Phone:312-259-9202
Mailing Address - Fax:
Practice Address - Street 1:16626 W 159TH ST STE 700
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-8019
Practice Address - Country:US
Practice Address - Phone:312-259-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002672101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional