Provider Demographics
NPI:1629420112
Name:KEMPNER, COLLEEN MANUEL (MSW, MA, LSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MANUEL
Last Name:KEMPNER
Suffix:
Gender:F
Credentials:MSW, MA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W FARRAGUT AVE
Mailing Address - Street 2:2W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2442
Mailing Address - Country:US
Mailing Address - Phone:952-564-4304
Mailing Address - Fax:
Practice Address - Street 1:2525 W FARRAGUT AVE
Practice Address - Street 2:2W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2442
Practice Address - Country:US
Practice Address - Phone:952-564-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.015780104100000X
IL149.0191241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical