Provider Demographics
NPI:1306427083
Name:KATELYN DIRCKS
Entity type:Organization
Organization Name:KATELYN DIRCKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIRCKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:708-743-1136
Mailing Address - Street 1:1135 GUINEVERE LN
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-9784
Mailing Address - Country:US
Mailing Address - Phone:708-743-1136
Mailing Address - Fax:
Practice Address - Street 1:8 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2514
Practice Address - Country:US
Practice Address - Phone:708-743-1136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty