MEDICARE: KATHARINE CADDELL LLC

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1467087593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHARINE CADDELL LLC

Provider Business Mailing Address
First Line	:	4524 W HUTCHINSON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1946
Country	:	US
Telephone Number	:	847-894-2972
Fax Number	:

Provider Business Practice Location Address
First Line	:	4006 N MILWAUKEE AVE STE 208
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1977
Country	:	US
Telephone Number	:	847-894-2972
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	KATHARINE HAUSMANN CADDELL
Credential	:	LCSW
Telephone Number	:	847-894-2972

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	03/09/2020

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