Provider Demographics
NPI:1437447885
Name:KEARNEY, ILONA SUSAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ILONA
Middle Name:SUSAN
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 2ND AVE E
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2675
Mailing Address - Country:US
Mailing Address - Phone:218-263-8147
Mailing Address - Fax:
Practice Address - Street 1:3229 2ND AVE E
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2675
Practice Address - Country:US
Practice Address - Phone:218-263-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical