Healthcare Provider Details

I. General information

NPI: 1154933893
Provider Name (Legal Business Name): KATRINA J MASON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2020
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4043 S DREXEL BLVD
CHICAGO IL
60653-2470
US

IV. Provider business mailing address

PO BOX 53614
CHICAGO IL
60653-0614
US

V. Phone/Fax

Practice location:
  • Phone: 773-729-7000
  • Fax:
Mailing address:
  • Phone: 773-729-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.018793
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: