Provider Demographics
NPI:1215357553
Name:SAUNDERS, KATHERINE A (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 E LAKE CTR STE 400
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-5803
Mailing Address - Country:US
Mailing Address - Phone:217-919-0437
Mailing Address - Fax:217-241-2790
Practice Address - Street 1:3837 E LAKE CTR STE 400
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5803
Practice Address - Country:US
Practice Address - Phone:217-919-0437
Practice Address - Fax:217-241-2790
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490165431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400135340Medicare PIN