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General NPI Number Information
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NPI Number | 1417828104
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Entity Type | Individual
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Provider Name | KATRINA ANN KING CARDENAS RPRS
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Gender | Female
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 10656 GOLDEN GATE AVE
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City | HUNTLEY
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State | IL
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Zip | 60142-4027
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Country | US
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Telephone | 540-272-8868
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Fax |
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Provider Business Mailing Address
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Address Line | 10656 GOLDEN GATE AVE
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City | HUNTLEY
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State | IL
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Zip | 60142-4027
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Country | US
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Telephone | 540-272-8868
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 0735001121
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 45346
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License Number State | IL
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