Provider Demographics
NPI:1306978861
Name:BROWN, KATHLEEN ELLEN (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ELLEN
Last Name:BROWN
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 1:1580 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 224C
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1444
Mailing Address - Country:US
Mailing Address - Phone:847-827-9090
Mailing Address - Fax:847-827-9096
Practice Address - Street 1:1580 N NORTHWEST HWY
Practice Address - Street 2:SUITE 224C
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1444
Practice Address - Country:US
Practice Address - Phone:847-827-9090
Practice Address - Fax:847-827-9096
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01606779OtherBLUE CROSS BLUE SHIELD
IL358280Medicare ID - Type Unspecified