Provider Demographics
NPI:1578322756
Name:OUTZEN, KATHLEEN A (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:OUTZEN
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 1:252 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-5650
Mailing Address - Country:US
Mailing Address - Phone:217-201-1786
Mailing Address - Fax:
Practice Address - Street 1:1170 E RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3566
Practice Address - Country:US
Practice Address - Phone:217-201-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490072461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical