Provider Demographics
NPI:1780950568
Name:FRIDDLE, KATHLEEN MARIE (MS, LCPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:FRIDDLE
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:RUZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCPC
Mailing Address - Street 1:1401 MCHENRY RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1382
Mailing Address - Country:US
Mailing Address - Phone:847-913-0393
Mailing Address - Fax:847-913-9630
Practice Address - Street 1:1401 MCHENRY RD
Practice Address - Street 2:SUITE 122
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1382
Practice Address - Country:US
Practice Address - Phone:847-913-0393
Practice Address - Fax:847-913-9630
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004443101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional