Provider Demographics
NPI:1780840116
Name:BYRER, KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:BYRER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 EDMONDS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3233
Mailing Address - Country:US
Mailing Address - Phone:815-274-9488
Mailing Address - Fax:
Practice Address - Street 1:39 E COLORADO AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1385
Practice Address - Country:US
Practice Address - Phone:815-469-1118
Practice Address - Fax:815-469-1119
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006292172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker