Healthcare Provider Details

I. General information

NPI: 1003745258
Provider Name (Legal Business Name): KATHRYN RAYNE KLINGLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 1604
CHICAGO IL
60602-3650
US

IV. Provider business mailing address

720 W WAVELAND AVE APT 3W
CHICAGO IL
60613-5323
US

V. Phone/Fax

Practice location:
  • Phone: 773-273-9831
  • Fax:
Mailing address:
  • Phone: 502-876-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.041133
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: