Provider Demographics
NPI:1497349443
Name:JIRASEK, KATHLEEN EGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:EGAN
Last Name:JIRASEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8824 S 82ND CT
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-1404
Mailing Address - Country:US
Mailing Address - Phone:708-699-8984
Mailing Address - Fax:
Practice Address - Street 1:8824 S 82ND CT
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-1404
Practice Address - Country:US
Practice Address - Phone:708-699-8984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0149381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical