Healthcare Provider Details

I. General information

NPI: 1952017634
Provider Name (Legal Business Name): KATHLEEN MARIE HANKES INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 GRAND AVE
FRANKLIN PARK IL
60131-3139
US

IV. Provider business mailing address

10001 GRAND AVE
FRANKLIN PARK IL
60131-2563
US

V. Phone/Fax

Practice location:
  • Phone: 847-455-5688
  • Fax: 847-455-0744
Mailing address:
  • Phone: 847-455-5688
  • Fax: 847-455-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: