Provider Demographics
NPI:1386734671
Name:KLINKHAMER, DORIS W (LCSW)
Entity type:Individual
Prefix:MS
First Name:DORIS
Middle Name:W
Last Name:KLINKHAMER
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 1:4449 N CALIFORNIA AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3803
Mailing Address - Country:US
Mailing Address - Phone:312-719-1926
Mailing Address - Fax:
Practice Address - Street 1:1165 N CLARK ST
Practice Address - Street 2:SUITE 413
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2702
Practice Address - Country:US
Practice Address - Phone:312-719-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
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
IL01633160OtherBC/BS PPO PROVIDER NUMBER