Provider Demographics
NPI:1871831180
Name:IRWIN, KATHERINE LURENE (LSW)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:LURENE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 CLEARLAKE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-8931
Mailing Address - Country:US
Mailing Address - Phone:800-292-3399
Mailing Address - Fax:217-365-9875
Practice Address - Street 1:2110 CLEARLAKE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-8931
Practice Address - Country:US
Practice Address - Phone:800-292-3399
Practice Address - Fax:217-365-9875
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.013960104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker