Healthcare Provider Details

I. General information

NPI: 1447554647
Provider Name (Legal Business Name): KATHRYN ESCATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN MARTIN

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 94 BOX 2269
APO AE
09824-0023
US

IV. Provider business mailing address

2416 EMERALD CT APT 205
WOODRIDGE IL
60517-3983
US

V. Phone/Fax

Practice location:
  • Phone: 314-676-6452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149016226
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: