Provider Demographics
NPI:1932626165
Name:SEGER, KATELYN (LAC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:SEGER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:SEGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:4018 N HAMLIN AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2106
Mailing Address - Country:US
Mailing Address - Phone:872-888-3246
Mailing Address - Fax:
Practice Address - Street 1:3234 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2594
Practice Address - Country:US
Practice Address - Phone:773-466-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001385171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist