Basic Information
| Provider Information | |||||||||
| NPI: | 1144591025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | DALY | ||||||||
| OtherFirstName: | KATIE | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 111 N COUNTY FARM RD | ||||||||
| Address2: | |||||||||
| City: | WHEATON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601873977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306827400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 422 N CASS AVE | ||||||||
| Address2: | |||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605591502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306827400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2012 | ||||||||
| LastUpdateDate: | 06/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149016582 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.