Provider Demographics
NPI:1275942229
Name:BRANDENBORG-CONTI, KATHRYN (PSYD, MA)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:BRANDENBORG-CONTI
Suffix:
Gender:F
Credentials:PSYD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 N SEELEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6115
Mailing Address - Country:US
Mailing Address - Phone:763-229-2202
Mailing Address - Fax:
Practice Address - Street 1:3523 N SEELEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6115
Practice Address - Country:US
Practice Address - Phone:872-216-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL071.009514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health