MEDICARE: KATHARINE CADDELL MA, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.014684	IL

General Provider Information

NPI Number	:	1407260797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHARINE CADDELL MA, LCSW

Provider Business Mailing Address
First Line	:	4524 W HUTCHINSON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1946
Country	:	US
Telephone Number	:	847-894-2972
Fax Number	:

Provider Business Practice Location Address
First Line	:	4006 N MILWAUKEE AVE STE 208
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1977
Country	:	US
Telephone Number	:	847-894-2972
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	04/14/2020

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