Provider Demographics
NPI:1194583583
Name:BLAHA, KATHLEEN LESLIE (LPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LESLIE
Last Name:BLAHA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 N SHERIDAN RD APT 702
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6562
Mailing Address - Country:US
Mailing Address - Phone:732-599-1641
Mailing Address - Fax:
Practice Address - Street 1:1400 E TOUHY AVE STE 300A&B
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-3305
Practice Address - Country:US
Practice Address - Phone:224-935-9015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional