=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194233940
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN ELAINE REAM LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2018
-----------------------------------------------------
Last Update Date | 03/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2104 N 76TH CT
-----------------------------------------------------
City | ELMWOOD PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60707-3005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-818-6922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16325 HARLEM AVE STE 200
-----------------------------------------------------
City | TINLEY PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60477-1688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-429-6999
-----------------------------------------------------
Fax | 708-429-6909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149.020038
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------