Provider Demographics
NPI:1285681080
Name:MERKLE, KATHRYN S (LCSW, MPH, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:MERKLE
Suffix:
Gender:F
Credentials:LCSW, MPH, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2417
Mailing Address - Country:US
Mailing Address - Phone:312-533-0707
Mailing Address - Fax:312-873-4003
Practice Address - Street 1:3921 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2417
Practice Address - Country:US
Practice Address - Phone:312-533-0707
Practice Address - Fax:312-873-4003
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005634133V00000X
IL149.0240661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered