Healthcare Provider Details

I. General information

NPI: 1356805386
Provider Name (Legal Business Name): KATHLEEN ESCALONA APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE STE 313
ORLAND PARK IL
60462-4687
US

IV. Provider business mailing address

15300 WEST AVE STE 313
ORLAND PARK IL
60462-4687
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-7878
  • Fax: 708-923-7888
Mailing address:
  • Phone: 708-923-7878
  • Fax: 708-923-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209018662
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209018662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: