Provider Demographics
NPI:1841522513
Name:PFAFFE, KATHY LYNN (LPSW, LPC, LMSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:PFAFFE
Suffix:
Gender:F
Credentials:LPSW, LPC, LMSW
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPSW, LPC, LMSW
Mailing Address - Street 1:224 1/2 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3112
Mailing Address - Country:US
Mailing Address - Phone:573-217-7797
Mailing Address - Fax:
Practice Address - Street 1:1221 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-4005
Practice Address - Country:US
Practice Address - Phone:573-221-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.002540101YP2500X
MO2010034145104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional