MEDICARE: KATHERINE KLINE LCSW, CRSS

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	149.022377	IL

General Provider Information

NPI Number	:	1487232583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE KLINE LCSW, CRSS

Provider Business Mailing Address
First Line	:	6033 N SHERIDAN RD STE S7
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-3013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6033 N SHERIDAN RD STE S7
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-3013
Country	:	US
Telephone Number	:	502-930-4775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	12/15/2021

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