Provider Demographics
NPI:1417574203
Name:VALENTIN, KATHY O (CADC)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:O
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:O
Other - Last Name:VALENTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1640 PLEASANT LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1847
Mailing Address - Country:US
Mailing Address - Phone:847-729-9017
Mailing Address - Fax:
Practice Address - Street 1:1640 PLEASANT LN
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1847
Practice Address - Country:US
Practice Address - Phone:847-729-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30008101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)