Provider Demographics
NPI:1700207768
Name:BLACKMER, KATHY (LPC, CADC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BLACKMER
Suffix:
Gender:F
Credentials:LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1861
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098
Mailing Address - Country:US
Mailing Address - Phone:815-245-6669
Mailing Address - Fax:815-334-1640
Practice Address - Street 1:13508 JULIE DR
Practice Address - Street 2:
Practice Address - City:POPLAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:61065
Practice Address - Country:US
Practice Address - Phone:815-245-6669
Practice Address - Fax:815-334-1640
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
IL178.008536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health