Provider Demographics
NPI:1568000602
Name:OLDHAM, KATIE (MA LCPC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 W JACKSON BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-5304
Mailing Address - Country:US
Mailing Address - Phone:630-418-6404
Mailing Address - Fax:
Practice Address - Street 1:2010 E ALGONQUIN RD STE 207
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4168
Practice Address - Country:US
Practice Address - Phone:847-359-5192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178015537101YP2500X
IL180.014112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional