Provider Demographics
NPI:1912653809
Name:LOCKWOOD, KATHLEEN MICHELE I
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MICHELE
Last Name:LOCKWOOD
Suffix:I
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:MICHELE
Other - Last Name:LOCKWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:703 E FALCON DR UNIT C103
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4371
Mailing Address - Country:US
Mailing Address - Phone:847-942-1582
Mailing Address - Fax:
Practice Address - Street 1:33 W HIGGINS RD STE 950
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9140
Practice Address - Country:US
Practice Address - Phone:314-275-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-22-204712106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician