| Doctor Name: | MS. KATHLEEN ELIZABETH BAUTISTA |
| NPI Number: | 1063836104 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 14916428 |
| Business Practice Address: | 252 E Washington St East Peoria, IL - 616112561 |
| Business Phone Number: | 3092826704 |
| Business Fax Number: | 3093872340 |
| Mailing Address: | 2467 Heather Ridge Dr, NORMAL |
| State: | IL |
| Postal Code: | 617615466 |
| Phone Number: | 3092422662 |
| Fax Number: | |
| NPI Enumeration Date: | 02/10/2014 |
| NPI Last Update Date: | 02/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 14916428 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |