Provider Demographics
NPI:1639786197
Name:DALLMANN, KATLYNN (LSW)
Entity Type:Individual
Prefix:
First Name:KATLYNN
Middle Name:
Last Name:DALLMANN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-4343
Mailing Address - Country:US
Mailing Address - Phone:773-804-8988
Mailing Address - Fax:
Practice Address - Street 1:3410 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-4343
Practice Address - Country:US
Practice Address - Phone:773-826-2929
Practice Address - Fax:773-826-2964
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.104323104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker