Healthcare Provider Details

I. General information

NPI: 1649249400
Provider Name (Legal Business Name): KATHRYN ANNE WEBSTER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 HALF DAY RD
BANNOCKBURN IL
60015-1241
US

IV. Provider business mailing address

30 E SCRANTON AVE #2
LAKE BLUFF IL
60044-2580
US

V. Phone/Fax

Practice location:
  • Phone: 847-317-7116
  • Fax:
Mailing address:
  • Phone: 847-317-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number096001292
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: