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General NPI Number Information
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NPI Number | 1659825396
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Entity Type | Individual
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Provider Name | KIMBERLY JEAN WATTS LCSW,MSW,CADC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 3004 GRAND AVE
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City | WAUKEGAN
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State | IL
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Zip | 60085-2321
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Country | US
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Telephone | 847-377-8120
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Fax |
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Provider Business Mailing Address
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Address Line | 10 HAWTHORNE LN
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City | FOX LAKE
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State | IL
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Zip | 60020-1809
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Country | US
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Telephone | 847-775-9552
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149019701
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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