Provider Demographics
NPI:1629838701
Name:FORD, KATHERINE JANE (LCPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JANE
Last Name:FORD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JANE
Other - Last Name:ONDERSMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1018 S POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-5556
Mailing Address - Country:US
Mailing Address - Phone:815-263-0679
Mailing Address - Fax:
Practice Address - Street 1:265 STEBBINGS CT STE 1
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1282
Practice Address - Country:US
Practice Address - Phone:815-200-8653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional