Provider Demographics
NPI:1699871004
Name:KLINE, WILLIAM (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:KLINE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E MAIN ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2900
Mailing Address - Country:US
Mailing Address - Phone:815-433-4748
Mailing Address - Fax:815-433-1955
Practice Address - Street 1:110 E MAIN ST
Practice Address - Street 2:SUITE 309
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2900
Practice Address - Country:US
Practice Address - Phone:815-433-4748
Practice Address - Fax:815-433-1955
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490027731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical