Provider Demographics
NPI:1497326367
Name:SIADAK, KATHERINE STORM (MSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:STORM
Last Name:SIADAK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4392
Mailing Address - Country:US
Mailing Address - Phone:630-880-9744
Mailing Address - Fax:
Practice Address - Street 1:1121 E MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2275
Practice Address - Country:US
Practice Address - Phone:630-518-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical