Provider Demographics
NPI:1134908155
Name:BOKERMANN, KATHERINE (EDS)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BOKERMANN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:DEWEESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:950 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4579
Mailing Address - Country:US
Mailing Address - Phone:630-861-4329
Mailing Address - Fax:
Practice Address - Street 1:950 S OAK ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4579
Practice Address - Country:US
Practice Address - Phone:630-861-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL954218103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool