Provider Demographics
NPI:1649363466
Name:KESSELRING, KATHLEEN E (MSW LCSW BCD)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:E
Last Name:KESSELRING
Suffix:
Gender:F
Credentials:MSW LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HAVEN ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2973
Mailing Address - Country:US
Mailing Address - Phone:630-782-6067
Mailing Address - Fax:
Practice Address - Street 1:103 HAVEN ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2973
Practice Address - Country:US
Practice Address - Phone:630-782-6067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02222628OtherBLUE CROSS BLUE SHIELD