Provider Demographics
NPI:1740627439
Name:LOVE, KATHLEEN M (MS, LAC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:LOVE
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:LOVE VILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAC
Mailing Address - Street 1:664 W HUBBARD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5509
Mailing Address - Country:US
Mailing Address - Phone:773-389-3320
Mailing Address - Fax:
Practice Address - Street 1:664 W HUBBARD ST FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5509
Practice Address - Country:US
Practice Address - Phone:773-389-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000653171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL198.000653OtherSTATE OF ILLINOIS