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NPI Code Detail

MEDICARE: MRS. KATHARINE COURTNEY CLARK-KEENE

MEDICARE: MRS. KATHARINE COURTNEY CLARK-KEENE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1227800000XCertified Respiratory TherapistBACB514668IL
2103K00000XBehavior Analyst1-21-48826IL

General Provider Information

NPI Number : 1255918637
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHARINE COURTNEY CLARK-KEENE
Provider Business Mailing Address
First Line : 3400 W STONEGATE BLVD STE 101-2109
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60005-1045
Country : US
Telephone Number : 331-241-6485
Fax Number :
Provider Business Practice Location Address
First Line : 3400 W STONEGATE BLVD STE 101-2109
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60005-1045
Country : US
Telephone Number : 331-241-6485
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2021
Last Update Date : 04/16/2021

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Directions to “ MRS. KATHARINE COURTNEY CLARK-KEENE ” Practice Location

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