Healthcare Provider Details

I. General information

NPI: 1427972025
Provider Name (Legal Business Name): KATHLEEN MARIE MCSHANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W 111TH ST
CHICAGO IL
60655-2715
US

IV. Provider business mailing address

10358 S CENTRAL PARK AVE
CHICAGO IL
60655-3110
US

V. Phone/Fax

Practice location:
  • Phone: 312-469-0486
  • Fax: 773-233-6111
Mailing address:
  • Phone: 773-891-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.130102
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: