Healthcare Provider Details

I. General information

NPI: 1548177017
Provider Name (Legal Business Name): KATRINA AGNES ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4431 LINCOLN HWY
MATTESON IL
60443-2317
US

IV. Provider business mailing address

4431 LINCOLN HWY
MATTESON IL
60443-2317
US

V. Phone/Fax

Practice location:
  • Phone: 708-748-1951
  • Fax: 708-748-1962
Mailing address:
  • Phone: 708-748-1951
  • Fax: 708-748-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: