Provider Demographics
NPI:1558711580
Name:O'DONNELL, KATHERINE JOY (LCSW, CADC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:JOY
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:JOY
Other - Last Name:VINKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CADC
Mailing Address - Street 1:130 N WEBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1518
Mailing Address - Country:US
Mailing Address - Phone:630-646-5514
Mailing Address - Fax:
Practice Address - Street 1:130 N WEBER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1518
Practice Address - Country:US
Practice Address - Phone:630-646-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30656101YA0400X
IL149.0184531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)