Provider Demographics
NPI:1952061293
Name:WYMAN, KATHERINE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:WYMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 WESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1313
Mailing Address - Country:US
Mailing Address - Phone:312-818-9885
Mailing Address - Fax:
Practice Address - Street 1:529 WESLEY AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1313
Practice Address - Country:US
Practice Address - Phone:312-818-9885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490241221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical