Provider Demographics
NPI:1831323989
Name:VAN HOUTEN, KATHRYN MARIE
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARIE
Last Name:VAN HOUTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MARIE
Other - Last Name:PENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 GAMBLE DR
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2369
Mailing Address - Country:US
Mailing Address - Phone:847-702-3850
Mailing Address - Fax:844-840-7347
Practice Address - Street 1:909 GAMBLE DR
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2369
Practice Address - Country:US
Practice Address - Phone:847-702-3850
Practice Address - Fax:844-840-7347
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist