Provider Demographics
NPI:1780495986
Name:JABLONSKY, KATHRYN CLAIRE (MED)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CLAIRE
Last Name:JABLONSKY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 W ADAMS ST UNIT 425
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3092
Mailing Address - Country:US
Mailing Address - Phone:815-321-3930
Mailing Address - Fax:
Practice Address - Street 1:2750 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1048
Practice Address - Country:US
Practice Address - Phone:773-435-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020348103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling