Provider Demographics
NPI:1194704056
Name:OPON, KATHLEEN RYAN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:RYAN
Last Name:OPON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 SHOALS DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-2222
Mailing Address - Country:US
Mailing Address - Phone:815-483-9185
Mailing Address - Fax:
Practice Address - Street 1:1109 SHOALS DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-2222
Practice Address - Country:US
Practice Address - Phone:815-483-9185
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical