Provider Demographics
NPI:1639899354
Name:KASIA, KAITLYNN MARKOWSKI
Entity Type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:MARKOWSKI
Last Name:KASIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLYNN
Other - Middle Name:ELIZABETH
Other - Last Name:MARKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1152 N KEDZIE AVE APT 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-4182
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 W JACKSON BLVD STE 515
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3061
Practice Address - Country:US
Practice Address - Phone:312-718-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0247241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical