Provider Demographics
NPI:1295050995
Name:UDOVICIC, KATHERINE ANNE (DT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:UDOVICIC
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:O'ROURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2415 W WINNEMAC AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2613
Mailing Address - Country:US
Mailing Address - Phone:773-306-3627
Mailing Address - Fax:
Practice Address - Street 1:2415 W WINNEMAC AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2613
Practice Address - Country:US
Practice Address - Phone:773-306-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist