Doctor Name: | KATHLEEN COLANGELO |
NPI Number: | 1013391002 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 071.009073 |
Business Practice Address: | 5000 S 5th Ave Hines, IL - 601413030 |
Business Phone Number: | 7082028387 |
Business Fax Number: | |
Mailing Address: | 1874 Great Plains Way, BOLINGBROOK |
State: | IL |
Postal Code: | 604905516 |
Phone Number: | 2169709911 |
Fax Number: | |
NPI Enumeration Date: | 07/20/2015 |
NPI Last Update Date: | 07/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 071.009073 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |