Provider Demographics
NPI:1558730838
Name:KINZLER, JOANNE OLDHAM (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:OLDHAM
Last Name:KINZLER
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 1:820 N ORLEANS ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3132
Mailing Address - Country:US
Mailing Address - Phone:312-607-2726
Mailing Address - Fax:
Practice Address - Street 1:820 N ORLEANS ST
Practice Address - Street 2:SUITE 216
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3132
Practice Address - Country:US
Practice Address - Phone:312-607-2726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490179581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical