Provider Demographics
NPI:1740752468
Name:WATLAND, KATHRYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:WATLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-2841
Mailing Address - Country:US
Mailing Address - Phone:815-774-1643
Mailing Address - Fax:
Practice Address - Street 1:201 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-2841
Practice Address - Country:US
Practice Address - Phone:815-774-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490196071041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool