Provider Demographics
NPI:1508116658
Name:HATCH, KATHRYNE (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHRYNE
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 CAMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8023
Mailing Address - Country:US
Mailing Address - Phone:630-885-0131
Mailing Address - Fax:
Practice Address - Street 1:15105 S JAMES ST STE 3
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2171
Practice Address - Country:US
Practice Address - Phone:630-885-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IL071009055103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst