Provider Demographics
NPI:1932512712
Name:MARTINEK, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MARTINEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MARTINEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2101 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1919
Mailing Address - Country:US
Mailing Address - Phone:847-299-2200
Mailing Address - Fax:847-299-7142
Practice Address - Street 1:2101 OXFORD RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-1919
Practice Address - Country:US
Practice Address - Phone:847-299-2200
Practice Address - Fax:847-299-7142
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL320900000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst