Provider Demographics
NPI:1962678599
Name:HANLON, KATHLEEN K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:K
Last Name:HANLON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:AGNES
Other - Last Name:KEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2424
Mailing Address - Country:US
Mailing Address - Phone:630-761-9750
Mailing Address - Fax:630-761-9752
Practice Address - Street 1:8 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2424
Practice Address - Country:US
Practice Address - Phone:630-761-9750
Practice Address - Fax:630-761-9752
Is Sole Proprietor?:No
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0109891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical