Basic Information
| Provider Information | |||||||||
| NPI: | 1669709366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINNEY | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 S DAMEN AVE | ||||||||
| Address2: | STE 205 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606081169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127385910 | ||||||||
| FaxNumber: | 3126666978 | ||||||||
| Practice Location | |||||||||
| Address1: | 1340 S DAMEN AVE | ||||||||
| Address2: | STE 205 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606081169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127385910 | ||||||||
| FaxNumber: | 3126666978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2009 | ||||||||
| LastUpdateDate: | 11/17/2009 | ||||||||
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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 | 104100000X | 150011676 | IL | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.