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NPI Code Detail

MEDICARE: KATHLEEN M. KOSTOCK LCSW

MEDICARE:   KATHLEEN M. KOSTOCK  LCSW
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
11041C0700XClinical Social Worker149001172IL

General Provider Information

NPI Number : 1598784431
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN M. KOSTOCK LCSW
Provider Business Mailing Address
First Line : 37512 N NORTH AVE
Second Line :
City : BEACH PARK
State : IL
Zip : 60087-2345
Country : US
Telephone Number : 312-590-8801
Fax Number :
Provider Business Practice Location Address
First Line : 37512 N NORTH AVE
Second Line :
City : BEACH PARK
State : IL
Zip : 60087-2345
Country : US
Telephone Number : 312-590-8801
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 07/13/2016

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Directions to “ KATHLEEN M. KOSTOCK LCSW” Practice Location

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