Provider Demographics
NPI:1437845823
Name:MACDONALD, KATHRYN KAMFJORD (LSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:KAMFJORD
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 W WRIGHTWOOD AVE APT 512
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2566
Mailing Address - Country:US
Mailing Address - Phone:630-386-2101
Mailing Address - Fax:
Practice Address - Street 1:1700 W IRVING PARK RD STE 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2596
Practice Address - Country:US
Practice Address - Phone:872-228-6416
Practice Address - Fax:833-968-2488
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
150.110572104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker