Provider Demographics
NPI:1669730198
Name:FISH, KERRIE DANIELLE (LCSW, CADC)
Entity type:Individual
Prefix:MRS
First Name:KERRIE
Middle Name:DANIELLE
Last Name:FISH
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:MISS
Other - First Name:KERRIE
Other - Middle Name:DANIELLE
Other - Last Name:NACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CADC
Mailing Address - Street 1:3010 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2321
Mailing Address - Country:US
Mailing Address - Phone:847-377-8120
Mailing Address - Fax:847-984-5691
Practice Address - Street 1:3004 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2321
Practice Address - Country:US
Practice Address - Phone:847-377-8120
Practice Address - Fax:847-984-5691
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IL30977101YA0400X
IL149.0179001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)