Provider Demographics
NPI:1518527894
Name:WARGIN, KATE (LAC)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:WARGIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:757 W DIVERSEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6505
Mailing Address - Country:US
Mailing Address - Phone:414-544-4775
Mailing Address - Fax:312-262-6364
Practice Address - Street 1:757 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6505
Practice Address - Country:US
Practice Address - Phone:414-544-4775
Practice Address - Fax:312-262-6364
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001458171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist