Healthcare Provider Details

I. General information

NPI: 1942128921
Provider Name (Legal Business Name): KATRYN IVASHNEV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LEXINGTON DR STE B
BUFFALO GROVE IL
60089-6929
US

IV. Provider business mailing address

1168 NORTHBURY LN APT B1
WHEELING IL
60090-2420
US

V. Phone/Fax

Practice location:
  • Phone: 224-676-0202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: