Healthcare Provider Details

I. General information

NPI: 1760946420
Provider Name (Legal Business Name): JANET KATSCHKE-HANSEN LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10540 S WESTERN AVE STE 506
CHICAGO IL
60643-2536
US

IV. Provider business mailing address

10540 S WESTERN AVE STE 506
CHICAGO IL
60643-2536
US

V. Phone/Fax

Practice location:
  • Phone: 773-233-5520
  • Fax: 773-701-6259
Mailing address:
  • Phone: 773-233-5520
  • Fax: 773-701-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JANET KATSCHKE-HANSEN
Title or Position: OWNER
Credential: LCPC
Phone: 773-233-5520