Healthcare Provider Details

I. General information

NPI: 1477160299
Provider Name (Legal Business Name): KATHERINE RACK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 N WINTHROP AVE APT 3E
CHICAGO IL
60640-6436
US

IV. Provider business mailing address

2501 CHATHAM RD STE 6508
SPRINGFIELD IL
62704-4188
US

V. Phone/Fax

Practice location:
  • Phone: 312-426-8731
  • Fax:
Mailing address:
  • Phone: 312-426-8731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.027301
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: