| Doctor Name: | KATHLEEN DIANE ELY |
| NPI Number: | 1104055714 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 149012496 |
| Business Practice Address: | 172 Brookhaven Court Sugar Grove, IL - 60554 |
| Business Phone Number: | 6304660019 |
| Business Fax Number: | 6308095062 |
| Mailing Address: | 172 Brookhaven Court, SUGAR GROVE |
| State: | IL |
| Postal Code: | 60554 |
| Phone Number: | 6304660019 |
| Fax Number: | 6308095062 |
| NPI Enumeration Date: | 07/06/2009 |
| NPI Last Update Date: | 09/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 149012496 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| 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 |