Provider Demographics
NPI:1689736639
Name:HARPER, KATHLEEN M (MSW LSCW BCD)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:HARPER
Suffix:
Gender:F
Credentials:MSW LSCW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W GREEN ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-3200
Mailing Address - Country:US
Mailing Address - Phone:217-328-7512
Mailing Address - Fax:217-328-6765
Practice Address - Street 1:301 W GREEN ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-3200
Practice Address - Country:US
Practice Address - Phone:217-328-7512
Practice Address - Fax:217-328-6765
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2012-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490023181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01072029OtherBCBS
210801Medicare ID - Type Unspecified