Provider Demographics
NPI:1912251901
Name:MARKS, KATHI (SPYD)
Entity Type:Individual
Prefix:DR
First Name:KATHI
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:SPYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1857
Mailing Address - Country:US
Mailing Address - Phone:847-917-4305
Mailing Address - Fax:
Practice Address - Street 1:466 MADISON AVE
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1857
Practice Address - Country:US
Practice Address - Phone:847-917-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.003473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical