Provider Demographics
NPI:1851453328
Name:SLATTERY, KATHLEEN T (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:T
Last Name:SLATTERY
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:KITTY
Other - Middle Name:
Other - Last Name:VENDEHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1250 GLENLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2504
Mailing Address - Country:US
Mailing Address - Phone:773-761-6693
Mailing Address - Fax:
Practice Address - Street 1:1250 GLENLAKE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660
Practice Address - Country:US
Practice Address - Phone:773-761-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.00010771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical