Healthcare Provider Details

I. General information

NPI: 1629568886
Provider Name (Legal Business Name): KATHERINE MEISNER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W ONTARIO ST STE 310
CHICAGO IL
60654-3621
US

IV. Provider business mailing address

222 W ONTARIO ST STE 310
CHICAGO IL
60654-3621
US

V. Phone/Fax

Practice location:
  • Phone: 312-880-9697
  • Fax: 773-585-6201
Mailing address:
  • Phone: 312-880-9697
  • Fax: 773-585-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227016369
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: