Healthcare Provider Details

I. General information

NPI: 1114731908
Provider Name (Legal Business Name): KATHERINE BODKIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SKOKIE BLVD STE 250
WILMETTE IL
60091-1167
US

IV. Provider business mailing address

335 WHITE OAK LN
WINNETKA IL
60093-3631
US

V. Phone/Fax

Practice location:
  • Phone: 847-201-4278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178020441
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: