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General NPI Number Information
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NPI Number | 1093406159
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Entity Type | Individual
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Provider Name | KEVIN OCKRIM LSW
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Gender | Male
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Dates
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Enumeration Date | 05/18/2023
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 501 DAVIS ST
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City | EVANSTON
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State | IL
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Zip | 60201-4619
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Country | US
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Telephone | 312-815-9660
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 TOWER DR UNIT 218
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City | GLENVIEW
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State | IL
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Zip | 60026-5824
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Country | US
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Telephone | 847-636-6254
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 150.110484
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License Number State | IL
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