Provider Demographics
NPI:1598202608
Name:PARKER, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 N BOSWORTH AVE
Mailing Address - Street 2:3R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2380
Mailing Address - Country:US
Mailing Address - Phone:970-948-0885
Mailing Address - Fax:
Practice Address - Street 1:1458 N BOSWORTH AVE
Practice Address - Street 2:3R
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2380
Practice Address - Country:US
Practice Address - Phone:970-948-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health