Healthcare Provider Details

I. General information

NPI: 1346023371
Provider Name (Legal Business Name): KATHRYN V BULANDR LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

IV. Provider business mailing address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

V. Phone/Fax

Practice location:
  • Phone: 224-306-1879
  • Fax: 210-306-1878
Mailing address:
  • Phone: 243-061-8792
  • Fax: 224-306-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.013036
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: