Healthcare Provider Details

I. General information

NPI: 1821360181
Provider Name (Legal Business Name): KATHLEEN E COX PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 WILLIAMS DR
ROSCOE IL
61073-9222
US

IV. Provider business mailing address

5290 WILLIAMS DR
ROSCOE IL
61073-9222
US

V. Phone/Fax

Practice location:
  • Phone: 815-324-0324
  • Fax: 866-927-3053
Mailing address:
  • Phone: 815-324-0324
  • Fax: 866-927-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN EUNICE COX
Title or Position: OWNER
Credential: LCPC
Phone: 815-324-0324