Healthcare Provider Details

I. General information

NPI: 1801232442
Provider Name (Legal Business Name): KATHERINE EILEEN KROMEKE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ILLINOIS RT 2
DIXON IL
61021
US

IV. Provider business mailing address

PO BOX 77 222 S ELM ST
FRANKLIN GROVE IL
61031-0077
US

V. Phone/Fax

Practice location:
  • Phone: 815-284-6611
  • Fax: 815-284-2834
Mailing address:
  • Phone: 815-994-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: