Provider Demographics
NPI:1366914376
Name:KANE, KASONDRA MARIE
Entity type:Individual
Prefix:
First Name:KASONDRA
Middle Name:MARIE
Last Name:KANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 LINCOLN HWY STE E
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2472
Mailing Address - Country:US
Mailing Address - Phone:708-748-1951
Mailing Address - Fax:708-748-1962
Practice Address - Street 1:4331 LINCOLN HWY STE E
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2472
Practice Address - Country:US
Practice Address - Phone:708-748-1951
Practice Address - Fax:708-748-1962
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator