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General NPI Number Information
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NPI Number | 1104058114
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Entity Type | Individual
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Provider Name | KATHLEEN ERIN ECCLES LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 3751 N PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60641-3136
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Country | US
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Telephone | 773-463-1200
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Fax | 773-463-1201
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Provider Business Mailing Address
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Address Line | 401 E PROSPECT AVE STE 214
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City | MT PROSPECT
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State | IL
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Zip | 60056-3396
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Country | US
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Telephone | 773-750-1776
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149013183
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License Number State | IL
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