Provider Demographics
NPI:1952172033
Name:KORPITZ, VICTORIA KATHERINE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:KATHERINE
Last Name:KORPITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 W 105TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4834
Mailing Address - Country:US
Mailing Address - Phone:708-704-4282
Mailing Address - Fax:
Practice Address - Street 1:300 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6597
Practice Address - Country:US
Practice Address - Phone:708-704-4282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical