| Doctor Name: | MS. THERESA ANN KENNEDY PATTON |
| NPI Number: | 1114210721 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCAS |
| License Number: | 26224 |
| Business Practice Address: | 24108 S Brookside Ct Crete, IL - 604172602 |
| Business Phone Number: | 7082797057 |
| Business Fax Number: | |
| Mailing Address: | 24108 S Brookside Ct, CRETE |
| State: | IL |
| Postal Code: | 604172602 |
| Phone Number: | 7082797057 |
| Fax Number: | |
| NPI Enumeration Date: | 05/16/2011 |
| NPI Last Update Date: | 04/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 26224 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |