MEDICARE: MS. KATHLEEN K HANLON 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	149.010989	IL

General Provider Information

NPI Number	:	1962678599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN K HANLON LCSW

Provider Business Mailing Address
First Line	:	8 S LINCOLN ST
Second Line	:
City	:	BATAVIA
State	:	IL
Zip	:	60510-2424
Country	:	US
Telephone Number	:	630-761-9750
Fax Number	:	630-761-9752

Provider Business Practice Location Address
First Line	:	8 S LINCOLN ST
Second Line	:
City	:	BATAVIA
State	:	IL
Zip	:	60510-2424
Country	:	US
Telephone Number	:	630-761-9750
Fax Number	:	630-761-9752

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

Provider Enumeration Date	:	05/04/2008
Last Update Date	:	05/04/2008

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