Healthcare Provider Details

I. General information

NPI: 1609560440
Provider Name (Legal Business Name): KATELYN MCCANN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N MICHIGAN AVE STE 1400
CHICAGO IL
60601-4011
US

IV. Provider business mailing address

1528 W HURON ST APT 2
CHICAGO IL
60642-7307
US

V. Phone/Fax

Practice location:
  • Phone: 312-815-9660
  • Fax: 312-235-1999
Mailing address:
  • Phone: 630-607-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150.114385
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: