Provider Demographics
NPI:1568984987
Name:KADLECK, KATHRYN (MSMFT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KADLECK
Suffix:
Gender:F
Credentials:MSMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 RIDGE AVE APT 705
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3878
Mailing Address - Country:US
Mailing Address - Phone:847-471-5183
Mailing Address - Fax:
Practice Address - Street 1:5407 EXCELSIOR BLVD STE AB&E
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2929
Practice Address - Country:US
Practice Address - Phone:612-787-2832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist