Provider Demographics
NPI:1770842882
Name:MENNINGER-KOKONTIS, CATHERINE (LCSW, ACSW, CADC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MENNINGER-KOKONTIS
Suffix:
Gender:F
Credentials:LCSW, ACSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 S 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6714
Mailing Address - Country:US
Mailing Address - Phone:708-819-1092
Mailing Address - Fax:708-579-1705
Practice Address - Street 1:10 CALENDAR CT
Practice Address - Street 2:SUITE F
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2323
Practice Address - Country:US
Practice Address - Phone:708-819-1092
Practice Address - Fax:708-579-1705
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22922101YA0400X
IL149.0145051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)