Provider Demographics
NPI:1851031694
Name:MCINTOSH, KAHTERA J (CD)
Entity Type:Individual
Prefix:MS
First Name:KAHTERA
Middle Name:J
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2381 GLEN FLORA AVE.
Mailing Address - Street 2:204
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085
Mailing Address - Country:US
Mailing Address - Phone:847-406-8186
Mailing Address - Fax:
Practice Address - Street 1:2381 GLEN FLORA AVE.
Practice Address - Street 2:204
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085
Practice Address - Country:US
Practice Address - Phone:224-303-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula