Provider Demographics
NPI:1942519160
Name:RETZNER, KATHLEEN O (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:O
Last Name:RETZNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MANCHESTER RD
Mailing Address - Street 2:SUITE 1510
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4579
Mailing Address - Country:US
Mailing Address - Phone:630-653-1717
Mailing Address - Fax:630-653-9691
Practice Address - Street 1:2100 MANCHESTER RD
Practice Address - Street 2:SUITE 1510
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4579
Practice Address - Country:US
Practice Address - Phone:630-653-1717
Practice Address - Fax:630-653-9691
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0131111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical