Healthcare Provider Details

I. General information

NPI: 1205747797
Provider Name (Legal Business Name): KATHERINE L ROSSETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 MAIN ST
ANTIOCH IL
60002-1807
US

IV. Provider business mailing address

416 N MILWAUKEE AVE
LIBERTYVILLE IL
60048-2248
US

V. Phone/Fax

Practice location:
  • Phone: 847-395-9001
  • Fax: 847-485-5715
Mailing address:
  • Phone: 773-382-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: