Provider Demographics
NPI:1124802749
Name:GALLOWAY, KATHERINE L (MSW, LSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:L
Other - Last Name:OEHLERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 SARAH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5334
Mailing Address - Country:US
Mailing Address - Phone:217-553-3958
Mailing Address - Fax:
Practice Address - Street 1:401 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5033
Practice Address - Country:US
Practice Address - Phone:217-545-7815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150104296104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker